Female, 56 years old, with right-sided weakness. Evaluate for stroke. Numerous patchy areas of restricted diffusion are seen within the left frontal lobe, corresponding to areas of hypoattenuation noted on prior CT. Also noted is a 13 mm region of restricted diffusion involving the left basal ganglia which likewise correlates to a lesion noted on prior CT.The affected regions above demonstrate corresponding T2 hyperintensity but there is no significant generalized mass effect. A single focus of susceptibility is noted within the left frontal lobe diffusion restricting region compatible with microscopic or petechial blood product. No significant intracranial hemorrhage is seen.The background brain demonstrates numerous scattered foci of white matter T2 hyperintensity which are not diffusion restricting and which likely correspond to chronic small vessel ischemic disease. No abnormal extra axial fluid collections are detected. The ventricles are normal in size and morphology.Motion artifact limits image quality of the MRA. No significant flow related signal is seen within the distal ICA, to the level of the communicating segment where some reconstitution of flow occurs. This is in agreement with findings noted on prior CTA. The left MCA vessels demonstrate reduced caliber when compared to those on the right, and in particular, the M2 branches of the superior division seem to be most conspicuously affected. The remaining intracranial vascular distributions are free of significant stenosis.
1.Patchy acute ischemia involving the left frontal lobe and left basal ganglia.2.Findings are likely related to complete or near complete occlusion of the left ICA with associated attenuation of some of the left MCA branch vessels.3.No evidence of significant hemorrhagic conversion is seen. Findings compatible with chronic microvascular ischemic disease are demonstrated.