58 years, Female, recent fall, recently diagnosed cancer. Parietal edema on CT. There is extensive FLAIR hyperintensity in the right parietal lobe cortex and subcortical white matter with T1 hyperintensity and susceptibility effect most consistent with laminar necrosis with also possible prior petechial hemorrhage in this region. There is extensive cortical enhancement in this region extending into the right temporal parietal operculum and right temporal occipital region. There is also a punctate focus of mild diffusion hyperintensity, isointense ADC, and T2 hyperintensity involving the left precentral gyrus most compatible with subacute infarct.There are additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as the pons which are nonspecific but compatible with mild chronic small vessel ischemic disease. There is no intracranial mass or mass effect. No significant intracranial mass effect. No midline shift or herniation.Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. Imaging findings most consistent with a late subacute, large infarct involving the right parietal lobe. 2. Punctate infarct which is likely subacute involving the left posterior frontal lobe.3. No evidence of intracranial metastatic disease.