 MRI OF THE BRAIN:A focus of intensely restricted diffusion is seen is seen in the left thalamus. Foci of more moderately restricted diffusion are also seen in the anterior left putamen, and in the left corona radiata. In the same distribution there is corresponding T2 and FLAIR high signal. Extensive nearly confluent periventricular white matter T2 hyperintensity is seen in the bilateral cerebral hemispheres, left side more than right. Small areas of encephalomalacia with corresponding susceptibility are evident in the right frontal and parietal operculum.Ventricular size is normal. No midline shift. No mass effect or edema. No evidence of herniation.MRA OF THE BRAIN:Within the limitations of a slightly degraded examination, no high-grade vascular stenosis or occlusion is suspected intracranially. A moderate left PCOM artery is seen. The right PCOM artery is not clearly identified.
1. A small focus of early acute ischemia is seen within the left thalamus. Small foci of slightly older, acute subacute ischemia are seen in the left anterior putamen and left corona radiata.2. The background brain shows evidence of prior cortical ischemia involving the right operculum, and extensive chronic microvascular ischemic disease.3. MRA demonstrates no evidence of high-grade stenosis.