66 years, Female, stroke, left-sided weakness sparing the face. Brain: There is restricted diffusion in the distal right anterior cerebral artery territory including the right paramedian frontal lobe extending into the paramedian parietal lobe with involvement primarily of the superior frontal gyrus and right paracentral lobule. There is associated T2/FLAIR hyperintensity without significant mass effect or evidence of hemorrhagic transformation. Additional punctate focus of diffusion hyperintensity in the right medial occipital cortex may be artifactual.There is an area of encephalomalacia involving the right anterior basal ganglia with susceptibility indicating chronic hemorrhage within this region. Additional chronic infarct involving the inferior medial aspect of the left cerebellar hemisphere is also noted. Foci of volume loss involving the anterior corpus callosum body and splenium are also evident. There is additional patchy T2/FLAIR hyperintensity in the periventricular and subcortical white matter compatible with mild to moderate chronic small vessel ischemic disease. No intracranial mass or mass effect. No hydrocephalus. No midline shift or herniation. Major flow-voids are preserved. Calvarium and extracranial soft tissue structures are grossly unremarkable. There are bilateral lens implants. Mild opacification of the left posterior ethmoid air cells also noted.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild reversal of cervical lordosis which may be partly positional. Alignment is otherwise maintained. Bone marrow signal is benign. Endplate edema on a degenerative basis is present at the C6-C7 level.Examination is motion degraded however no obvious cord signal abnormality is appreciated. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex. No significant compromise to the spinal canal. There is mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy. Right neural foramen is patent.C4-5: Small disc osteophyte complex and uncovertebral hypertrophy. There is mild to moderate right neural foraminal narrowing. Left neural foramen is patent.C5-6: No significant spinal canal stenosis. There is mild right neural foraminal narrowing related to uncovertebral hypertrophy. There is minimal left neural foraminal narrowing related to facet arthropathy.C6-7: Small disc osteophyte complex with minimal left neural foraminal narrowing. Spinal canal and right neural foramen are patent. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Acute infarct involving the right paramedian frontal and parietal lobes. No associated mass effect or hemorrhagic transformation.2. Chronic infarct with evidence of prior hemorrhage in the right anterior basal ganglia. Chronic left inferior cerebellar infarct also noted. There is also a background of mild to moderate chronic small vessel ischemic disease.3. Mild multilevel degenerative changes in the cervical spine without significant spinal canal stenosis at any level. No definite cord signal abnormality. Multilevel neural foraminal stenosis as described above without high-grade stenosis at any level.Findings were discussed with Dr. Fabiane at 1148 hours on 8/31/2016.