Unspecified cerebral artery occlusion with cerebral infarction.Clinical question: h/o R frontotemporal stroke with hemorrhagic conversion in 3/2015. Re-asses for malignancySigns and Symptoms: stroke vs malignancy, assess for vascular disease MRI of the brainThere is a focus of encephalomalacia along the right frontal lobe at the junction of right superior and middle frontal gyri which has evolved since the prior exam from 3/3/2015. There are associated small foci of susceptibility present in the adjacent tissues. Some are gyral based and represent petechial blood while a couple others represent small hemorrhages.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left A1 segment is larger than the right A1 segment. The intracranial vasculature is irregular.The right internal carotid artery is irregular and narrowed at the level of the distal cavernous segment with focal fusiform dilation at the clinoidal segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the left PCA. The right p1 segment is hypoplastic. The right PCOMA and the right P1 segment are similar in diameter.There is high grade stenosis at the distal right vertebral artery.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Right frontal lobe infarction in evolution since late February associated with petechial blood and small foci of hemorrhagic conversion.4.There is high grade stenosis at the distal right vertebral artery.5.The right ICA is mildly narrowed with a focal dilation at the clinoidal segment.6.The intracranial vasculature is irregular and atherosclerotic appearing.