52 years Female (DOB:2/24/1964)Reason: left parietal lesion progression History: AphasiaPROVIDER/ATTENDING NAME: AGNIESZKA A ARDELT AGNIESZKA A ARDELT There is diffusion restriction present along the posterior aspect of the left temporal lobe and left parietal lobe. There is a gyriform pattern of diffusion restriction gyriform pattern along the left occipital lobe adjacent to the involved parietal and temporal lobes. There are some additional involvement of the posterior aspect of the left paracentral lobule which is expected to be in the anterior cerebral artery territory as well as the posterior aspect of the left cingulate gyrus. There is associated FLAIR signal abnormality as well as cerebral swelling and sulcal effacement and compression of the left lateral ventricle. The FLAIR signal abnormality appears to be greater than the diffusion-weighted signal abnormality. There is no evidence for associated hemorrhage.There are several foci of the punctate diffusion restriction in the right cerebellar hemisphere inferiorly. This associated with FLAIR signal abnormality.There is a small focus of T2 and FLAIR signal hyperintensity along the posterior aspect of the left thalamus measuring 8 mm in diameter.Postcontrast imaging is significantly degraded due to patient motion. There appears to be leptomeningeal enhancement centered along the left temporal parietal and occipital lobes.There is redemonstration of patchy FLAIR and T2 signal in the pons.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Findings are suggestive of of infarction involving left parietal occipital and temporal lobes. These may represent infarctions in different stages. There is associated mass effect. The pattern of involvement is a bit unusual given the coincidental involvement of 3 adjacent cerebral artery territories and the relative lack of diffusion restriction through much of the abnormality. The possibility of underlying infection, inflammation or other cause is raised.2.There are foci of microinfarction in the inferior aspect of the right cerebellar hemisphere.3.A left thalamic lesion is present. This could represent prior lacunar infarct. However, it is unclear.4.Postcontrast imaging is degraded by patient motion artifact which will obscure more subtle abnormalities.5.Lesions in the pons are suspected be vascular related.