Reason: new ischemia, brain metastasis History: new RLE weakness, left neck mass There is encephalomalacia involving the right superior and middle temporal gyri as well as the right inferior parietal lobule. There is associated susceptibility effect in the right parietal lobe gyri.No foci of diffusion restriction are appreciated intracranially.There are T2 and flair signal hyperintensity is present along the left basal ganglia and left internal capsule and to a lesser degree right basal ganglia.T2 and flair signal hyperintensity associated volume loss is present along the left corticospinal tract extending from the cerebral cortex to the medulla.There is a punctate signal hypointensity on the susceptibility weighted images in the left cerebellar hemisphere. Another one is present in the left occipital lobe subcortical white matter . Small punctate hypointensities on the susceptibility weighted images associated with a small amount of encephalomalacia are present in the right frontal lobe and left parietal lobe.No abnormal enhancing masses are appreciated intracraniallyNormal 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.
1.There is no evidence for acute ischemic cerebral infarction appreciated.2.There is encephalomalacia involving right parietal lobe and the right temporal lobe along the inferior division of the middle cerebral artery distribution.3.Punctate microhemorrhages are present some of which are associated with small foci of encephalomalacia4.remote lacunar infarct is present in the left basal ganglia.5.Findings suggest wallerian degeneration along the left corticospinal tract extending from the cerebral cortex to the medulla.6.No evidence for brain metastases.