aphasia There are multiple high signal intensities on DWI, specifically, on the right frontal lobe pre central gyrus and superior frontal gyrus. Among them, a small foci of high signal intensity on DWI shows restricted diffusion on ADC map, thus indicate acute ischemic infarction. Other lesions likely represent evolving subacute ischemic infarction. There is no evidence of hemorrhagic conversion on this scan.Significant encephalomalacia on the right temporal lobe likely represent chronic ischemic infarction is seen with ex vacuo changes of right lateral ventricle.On FLAIR images, patchy high signal intensity lesions on bilateral periventricular white matter indicate non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses are clear.The left mastoid air cells show fluid collection, thus clinical correlation for possible mastoiditis is recommended.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal bilateral ICAs, ACAs and MCAs. Vertebrobasilar system appears to be normal. No evidence of intracranial arterial luminal stenosis, occlusion or arterial aneurysm.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 20-30% luminal narrowing on the right extracranial ICA just above the bifurcation. Otherwise normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the left common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Multifocal evolving ischemic infarctions most of them are subacute or older on the right frontal lobe with a single restricted diffusion lesion on the right frontal lobe superior frontal gyrus. No evidence of hemorrhagic conversion.2. Chronic ischemic infarction on the right temporal lobe with encephalomalacia.3. Non specific small vessel ischemic disease.4. Normal brain MRA.5. Minimal to mild luminal narrowing on the right extracranial ICA just above the bifurcation (about 20-30%) 6. Fluid collections on the left mastoid.