Acute worsening of right hemiparesis. History of cocaine abuse with recurrent strokes. Per technologist note, patient refused to complete the examination because of nausea. Only diffusion, axial T2, axial FLAIR and sagittal T1 sequences were obtained.There is a small diffusion positive lesion along the right corona radiata, which at least partly seems to correlate with ADC reduction. This correlates with focal T2-hyperintensity and may represent a subacute infarct. Otherwise, there is no territorial diffusion restriction. There is no gross intracranial mass or mass-effect. There is no midline shift or brain herniation. There is relatively moderate burden of patchy T2-hyperintense lesions in the frontal white-matter, thalami right more than left, and brainstem. There is also confluent periventricular T2-hyperintensity. These findings are nonspecific but likely reflect microvascular ischemia.The major intracranial vascular flow voids are preserved. The orbits are grossly unremarkable. There is trace anterior ethmoid mucosal thickening.
1.Limited, incomplete examination given patient intolerance, as described above.2.Focus of diffusion hyperintensity and T2 hyperintensity involving the right corona radiata which is suspected to represent a subacute infarct. There is otherwise no evidence of acute infarct. 3.Moderate cerebral white-matter, thalamic and brainstem nonspecific T2-hyperintense lesions likely reflect microvascular ischemia.Dr. Monther Qandeel discussed the above findings with Dr. Reeti Raychaudhuri at pager 1844 over the phone on 6/8/2016 at 4:35 PM. 