51 years Female (DOB:3/19/1965)Reason: 51F with recurrent lung cancer, OSH transfer for Strep pneumo bacteremia and respiratory failure requiring intubation, now with left-sided paralysis and right MCA CVA, ?embolic, ?ischemic, ?other lesions History: 51F with recurrent lung cancer, OSH transfer for Strep pneumo bacteremia and respiratory failure requiring intubation, now with left-sided paralysis and right MCA CVA, ?embolic, PROVIDER/ATTENDING NAME: BRYAN A CAMPBELL ANSHU A VERMA MRI of the brainThere is cortically based diffusion restriction present along the right middle frontal gyrus as well as the medial lateral aspect of the right superior frontal gyrus and along the left middle frontal gyrus as well as the precentral gyri bilaterally and the right postcentral gyrus. This associated with it T2 signal hyperintensity in the underlying white matter. These findings are new when compared to the prior examThe CSF spaces are appropriate for the patient's stated age with no midline shift. On susceptibility imaging there is vascular or dilation along the high convexities of the right frontal lobe.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery and the posterior communicating arteries are identified and are intact.There is extracranial origin of the left posterior inferior cerebellar artery.. There is extracranial origin of the right posterior inferior cerebellar artery. There is effectively an azygos A2 segment left anterior cerebral arteries smaller than the right anterior cerebral artery at the level of the A1 segments. The anterior communicating artery is present. The left frontopolar artery originates from the left A1-ACOMA junction.The superior division of the right middle cerebral artery is dominant whereas the inferior division of the left middle cerebral artery is dominant.
1.Findings suggest a cortically based infarction associated with underlying edema which is new since the prior exam explanations may include RCVS, vasculitis as well as encephalitis and ischemia. This is new since the MRI from 8/27/2016.2.There is a vascular microdilation along the high convexities of the right hemisphere. One possible explanation is that this represents a collateral recruitment with associated distal branch occlusions. A conventional angiogram would help differentiate.3.Please note that there is an azygos A2 segment predominately supplied from the right internal carotid artery.4.At the time of this dictation we attempted to contact the clinical service to discuss the findings (pager 3658) We are awaiting a callback