Two weeks of left frontal head ache, one week of right upper extremity weakness and one day of aphasia and mild cognitive problem. Left frontal hypodensity, hydrocephalus, and temporal atrophy. Multifocal areas of restricted diffusion are noted in the left frontal lobe, left medial basal ganglia, left precentral gyrus, and left posterior parietal region indicating acute ischemic infarcts. The largest region of infarct is along the left frontal lobe cortex. There is some degree of sulcal effacement along the left frontal lobe. However, there is no midline shift or herniation. There is additional patchy periventricular and subcortical white matter signal abnormality indicating superimposed small vessel ischemic disease. There is no evidence of intracranial hemorrhage or abnormal intracranial enhancement. The ventricles are non-enlarged. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Multifocal areas of restricted diffusion compatible with acute infarct greatest in the left frontal lobe but also smaller infarcts in the basal ganglia and left parietal regions.2.No evidence of intracranial hemorrhage, midline shift or herniation. 3.Superimposed chronic small vessel ischemic disease.