Diagnosis: Altered mental status. Personal history of other disorders of nervous system and sense organsClinical question: unclear hx of seizure disorder, SDH, CVA, residual R hemiparesis Arm > LSigns and Symptoms: transferred from OSH for AMS There is encephalomalacia involving the left inferior frontal gyrus as well as portions of the left middle frontal gyrus and in the left pre and postcentral gyri and left insular cortex within the left middle cerebral artery territory. There is associated atrophy of the left cerebral peduncle with signal change compatible with Wallerian degeneration. There is associated susceptibility effect within the area of infarction. There is ex vacuo effect on the left lateral ventricle. There are associated flow voids within the left sylvian fissure middle cerebral artery vasculature.No foci of diffusion restriction are appreciated to suggest acute ischemic cerebral infarction.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal right carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The left internal carotid artery lumen has high signal within it at the petrous segment..The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Findings are suspicious for old infarction with encephalomalacia in the left middle cerebral artery territory as detailed above with associated Wallerian degeneration.2.Occlusion or near occlusion of the left internal carotid artery.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific.4.There is no evidence for acute ischemic cerebral infarction.