68-year-old female patient left sided weakness, recent TIA versus stroke. Evaluate for signs of ischemia, infarction, or mass. MRI: There is restricted diffusion and high T2 signal in the right basal ganglia and corona radiata. There are areas of encephalomalacia with susceptibility effect in the left basal ganglia and corona radiata, bilateral thalami, and right cerebellar hemisphere. There are also a few scattered supratentorial and infratentorial punctate foci of susceptibility effect without associated gross encephalomalacia. There is a background of cerebral white matter T2 hyperintensity without restricted diffusion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There appears to be at least mild narrowing of the bilateral proximal middle cerebral arteries. There is also narrowing of the left posterior cerebral artery in the P2 segment region. There is mild irregularity of the bilateral carotid siphons. Otherwise, there is no evidence of significant occlusive lesions or aneurysms. There is an incidental right fetal PCA.
1. Acute infarction in the right basal ganglia and corona radiata with a punctate focus of susceptibility in this area, which may represent associated petechia hemorrhagic transformation versus pre-existing chronic microhemorrhage or calcification.2. Chronic left basal ganglia and corona radiata, bilateral thalamic, and right cerebellar lacunar infarcts with associated chronic hemorrhages, superimposed upon chronic small vessel ischemic disease. 3. Apparent narrowing of the bilateral proximal middle cerebral arteries, as well as the left posterior cerebral artery. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.