Female, 51 years old, with cerebral infarct, assess for RCVS versus vasculitis versus ischemia versus neurosyphilis. The pattern of mild cortical restricted diffusion affecting the bilateral frontal and parietal lobes, right side more than left, has not significantly changed. No definite evidence of any new diffusion restricting lesion is seen. FLAIR hyperintensity within the cortical and subcortical tissues corresponding to the areas of restricted diffusion is also unchanged. The affected gyri are mildly edematous, but there is no significant generalized mass effect, midline shift or brain herniation. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is detected. The ventricles remain normal in size and morphology. On postcontrast images, the affected tissues demonstrate gyriform enhancement. MRA images of the head are limited due to motion. However, no significant intracranial vascular stenosis is appreciated. Azygos configuration of the ACA is again demonstrated.
Findings are again seen compatible with subacute ischemia affecting the cortex of the bilateral frontal and parietal lobes, right side more than left. Since the prior examination, there has been no significant expansion in the abnormality, and no generalized mass effect is seen.