Personality change. Rule out ICH. Significant atherosclerotic calcifications are noted in the internal carotid arteries and vertebral arteries. Extensive low-attenuation in the right MCA distribution with significant volume loss and ex vacuo dilatation of the right lateral ventricle is consistent with a chronic right MCA infarct. If there is clinical concern for acute ischemia, an MRI with diffusion-weighted images is recommended for further evaluation. No acute intracranial hemorrhage is identified. No evidence of midline shift. The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
Chronic right MCA infarct. If there is clinical concern for acute ischemia, an MRI with diffusion-weighted images is recommended for further evaluation.