Reason: Please Eval for new stroke History: right sided hemiparesis, slurred speech, aphasia, left field cut MRI brain:Multiple punctate foci of diffusion restriction with matching ADC hypointensity is present in the posterior left frontal lobe, right cerebellar vermis, left putamen as well as in the right frontal and parietal lobes representing acute ischemia. There is volume loss and encephalomalacia from prior right PCA stroke. Additional scattered foci of increased T2 signal including pontine and left parietal T2 hyperintense regions are unchanged and represent foci of chronic small vessel ischemic disease.There is no evidence of intracranial hemorrhage or mass. There is mild ex vacuo dilatation of the right occipital horn adjacent to the evolving infarct. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Complete opacification of the left maxillary sinus is unchanged.MRA brain:Multifocal areas of luminal irregularity throughout the anterior and posterior circulation. Stenosis of the right M1 segment to about 30% is unchanged. Luminal irregularities in the vertebrobasilar system are also unchanged, however no significant regions of stenosis are identified. No aneurysms are identified.MRA neck:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.
1.Multiple punctate foci of diffusion restriction consistent with acute ischemia in both supratentorial and tentorial brain suggestive of an embolic origin.2.Expected evolution of old right PCA infarct.3.Multifocal regions of intracranial luminal narrowing suggests diffuse atherosclerotic disease and is unchanged.4.No significant stenosis, aneurysm or dissection in the extracranial carotid or vertebrobasilar systems.