83 years, Female, right-sided weakness and aphasia. There are areas of restricted diffusion involving the left posterior frontal and anterior parietal lobes including the pre and post central gyri and extending laterally into the operculum. There is corresponding T2/FLAIR hyperintensity. There is a 4 mm focus of susceptibility effect involving the left lateral post central gyrus suspicious for hemorrhagic transformation. No significant edema or mass effect.Again seen are multiple chronic infarcts including the right parieto-occipital lobes and bilateral cerebellar hemispheres with evolution of the previously seen right superior cerebellar artery territory infarct on prior MRI from 2/17/2011. There is susceptibility compatible with chronic hemosiderin deposition involving the prior right cerebellar infarct.No intracranial mass or mass effect. No extra-axial collections. No hydrocephalus. Bilateral T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter is compatible with background of moderate chronic small vessel ischemic disease. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.
1. Acute infarct involving the left posterior frontal and anterior parietal lobes including the pre and post central gyri and extending laterally into the operculum. There is a 4 mm focus of susceptibility involving the left lateral post central gyrus suspicious for minor hemorrhagic transformation.2. Multiple chronic infarcts including the right parietal lobe as well as bilateral cerebellar hemispheres. There has been interval evolution of the previously seen large right superior cerebellar artery territory infarct seen on MRI dated 2/17/2011 with chronic hemosiderin deposition also present in this region. 3. Evidence of moderate chronic small vessel ischemic disease also again seen.Dr. Ali discussed findings with Dr. Del Brutto Andrade at 930 hrs on 11/15/2015.