55-year-old male with left-sided weakness There is no evidence of acute intracranial hemorrhage or midline shift. There has been continued evolution of the previously seen subacute stroke in the distribution of the right MCA with more prominent encephalomalacia (involving the right frontal, parietal and temporal lobes) and associated ex vacuo dilatation of the right lateral ventricle. A second previously noted focus of encephalomalacia in the right occipital lobe is also again seen appearing similar to the prior MRI of the brain from 3/2011. Additional patchy areas of hypodensity are seen in the periventricular and subcortical white matter likely represent small vessel ischemic disease of indeterminant age. A hyperdense proximal right MCA is again noted which may represent intraluminal clot, grossly unchanged.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. A left ethmoid sinus benign osteoma is again noted.
1. No acute intracranial hemorrhage. CT is insensitive for the early diagnosis of acute nonhemorrhagic CVA.2. Continued evolution of an old right MCA CVA.