New left middle cerebral artery infarct. In the recently demonstrated areas of loss of gray-white matter differentiation in the left parietal lobe, including the inferior precentral gyrus, there is diffusion restriction and high T2 signal. There are additional small areas of diffusion restriction in the posterior left temporal lobe and left insula. There is a background of extensive high T2 signal in the periventricular and subcortical white matter. There is encephalomalacia in the bilateral corona radiata and basal ganglia with unchanged areas of susceptibility effect. There is diffuse prominence of the ventricles and sulci due to cerebral volume loss. There is no evidence of acute intracranial hemorrhage or mass. There is no midline shift or herniation. The major cerebral flow voids are grossly intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Acute to early subacute infarcts in the left middle cerebral artery territory involving the left parietal lobe, posterior temporal lobe, and insula, but no evidence of acute intracranial hemorrhage or midline shift.2. Extensive chronic small vessel ischemic disease and chronic infarcts in the bilateral corona radiata and basal ganglia.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.