81 year old female patient with right-sided visual field deficit, visual hallucinations. Question of stroke. BRAIN: There is extensive encephalomalacia involving the right frontal, parietal, and temporal lobes as well as the right basal ganglia with associated ex-vacuo dilatation of the right lateral ventricle. Surrounding susceptibility artifact within this area likely represents chronic blood products. There is Wallerian degeneration of the right pons and right cerebral peduncle. There is a focus of diffusion restriction within the region of the motor cortex within the right precentral gyrus without definite evidence of ADC restriction; this could be artifactual or represent a small ischemic lesion. Otherwise, there is no diffusion-weighted abnormalities to suggest acute ischemia. There is extensive subcortical and periventricular abnormal T2 signal within the right cerebral hemisphere and mild T2 signal abnormality within the left cerebral hemisphere consistent with chronic small vessel ischemic disease. There is no midline shift or herniation. There is attenuation of the M1 segment of the right middle cerebral artery flow void. There is fluid in the left mastoid air cells. ORBITS: The bilateral globes and ocular adnexa are unremarkable, other than bilateral lens implants. There is no evidence of abnormal intraorbital enhancement or mass lesions.
1. Extensive right cerebral hemispheric encephalomalacia in the distribution of the right middle cerebral artery.2. A focus of diffusion restriction within the right precentral gyrus without definite evidence of ADC restriction; this could be artifactual or represent a small ischemic lesion.3. Chronic small vessel ischemic disease. 4. Unremarkable examination of the bilateral orbits.