 MRI BRAIN: There is gyriform restricted diffusion and T2 hyperintensity involving the left middle and inferior frontal gyri with mild swelling. There are two additional punctate foci of restricted diffusion and T2 hyperintensity in the left inferior cerebellar hemisphere. There are scattered punctate foci of susceptibility effect in the left superior cerebellar hemisphere, and right frontal periventricular white matter and left middle frontal gyrus, which may represent chronic microhemorrhages. There is periventricular and subcortical nonspecific white matter T2 signal abnormality with additional patchy T2 signal abnormality in the central pons. There is a defect in left basal ganglia. The ventricles and sulci are diffusely prominent suggesting cerebral volume loss. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. MRA BRAIN: The anterior and posterior circulations show no evidence of high-grade steno-occlusive disease or aneurysm. MRA NECK: There is suboptimal depiction of the great vessel origins due to technical factors. Otherwise, the bilateral common carotid arteries, cervical internal carotid arteries, and vertebral arteries are without evidence of high grade stenosis.
1.Acute nonhemorrhagic cortical infarction involving the left middle and inferior frontal gyri, as well as punctate acute left inferior cerebellar hemispheric infarcts.2.No evidence of significant steno-occlusive disease in the head or neck].3.Chronic left basal ganglia infarct.4.Chronic microvascular ischemic changes as described above.Findings were discussed with Dr. Andrew Beaser (CCU Fellow) over the telephone at 4:06 PM today.