Persistently altered mental status. MRI: There is a 3 cm wide area of gyriform restricted diffusion and high T2 signal in the right precentral gyrus. There are also several punctate foci of restricted diffusion and high T2 signal in the subcortical white matter of the right occipital lobe and left frontal lobes. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is bilateral tympanomastoid fluid.MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms. There is a fetal right posterior cerebral artery.
1. Moderate-sized recent infarction involving the right precentral gyrus and punctate recent infarcts in the right occipital lobe and left frontal lobes, which may be embolic in nature.2. No evidence of significant steno-occlusive lesions of the proximal intracranial arteries. Vascular imaging of the neck may be useful for further evaluation.3. Diffuse cerebral volume loss.4. Nonspecific bilateral tympanomastoid effusions.