right side face and arm weakness, worse overnight. known pancreatic cancer. There are multifocal bihemispheric as well as bilateral cerebellar hemispheric restricted diffusion lesions indicating acute ischemic infarction. The most prominent restricted diffusion lesions are on the left side fronto-parietal white matter which correspond to the patient's clinical symptom.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. Ventricle size remains within normal limits. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate sudden cut off of the left MCA M2 segment indicate embolic occlusion. However, a frontal branch of the left MCA and left angular artery appear to be patent. Acom artery is patent.Left PCA is fetal origin and the right Pcom artery is patent. There is no evidence of intracranial arterial aneurysm.
1. Bihemispheric and cerebellar hemispheric multifocal scattered acute ischemic infarctions without evidence of hemorrhagic conversion as described above.2. Occlusion of the left MCA proximal M2 segment with frontal branch and left angular artery patency. 