 There is a gyriform pattern of faint restricted diffusion in the left parietal and occipital lobes consistent with subacute infarction. There is an associated large area of T2/FLAIR hyperintensity involving the left parietal, occipital and posterior temporal lobes compatible with edema. There is associated susceptibility in this region related to petechial blood products.Additional scattered areas of susceptibility changes are noted in the bilateral cerebral hemispheres right more than left.There is a large area of encephalomalacia involving the right MCA territory as seen on prior CT, with ex vacuo dilatation of the right lateral ventricle. There is atrophy of the right cerebral peduncle related to wallarian degeneration. There is encephalomalacia involving the right inferior cerebellar hemisphere likely from prior ischemia, unchanged.There is a small infarct in the left posterior frontal lobe inferiorly at the junction of superior frontal gyrus and middle frontal gyrus, chronicity of which is uncertain.No herniation or midline shift. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the bilateral maxillary sinuses including retention cyst in the left maxillary sinus as well as mild mucosal thickening in the ethmoid sinuses. There is fluid within the nasopharynx and posterior nasal cavity likely related to recent intubation. There is right-sided craniotomy.BRAIN MRI
1.Faint gyriform pattern of restricted diffusion in the left parietal and occipital lobes compatible with subacute infarct. Associated large area of T2 signal abnormality likely represents edema related to the infarct.2. Focal infarct in the left frontal lobe of uncertain age but likely late subacute or chronic.3. Extensive chronicinfarct involving the right MCA territory as well as a chronic infarct in the right cerebellum.4. Periventricular and subcortical white matter T2 signal hyperintensities related to chronic small vessel ischemic changes.5. Paucity of distal branches of the right MCA beyond the bifurcation corresponding to the right MCA territory encephalomalacia, but otherwise no significant narrowing in the anterior or posterior circulation.6. No evidence of marrow signal changes or ligamentous injury to account for cervical spine trauma.7. Mild degenerative changes in the cervical spine mostly at C5-C6 with resultant moderate narrowing of left neural foramen. No evidence of central canal stenosis at any level.