79 years Male (DOB:8/24/1936)Reason: stroke History: weakness, dysarthriaPROVIDER/ATTENDING NAME: NAVNEET CHEEMA RIMAS V LUKAS There is a patchy diffusion restriction present involving small portions of the right centrum semiovale, a short segment of the lateral aspect of the right precentral gyrus and a couple punctate foci along the right insular cortex and right subcentral lobule. On susceptibility imaging there is asymmetrically low signal along the right operculum adjacent to this are of diffusion restriction at the expected location of an M3 branch associated with low SWI signal in the adjacent tissues in a 27x20mm axial dimension area. There is a punctate focus of signal loss along the left half of the genu of the corpus callosum on SWI.There a punctate foci of T2/FLAIR signal hyperintensity present along the right thalamus and right caudate nucleus. The ones in the right caudate nucleus were present on the 7/23/2004 exam.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images with a couple additional punctate FLAIR and T2 hyperintense lesions in the cerebellum. This has mildly progressed since 2004.Normal vascular flow voids are present in the distal carotid and left 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 right vertebral artery flow void is not identified.The visualized portions of the paranasal sinuses demonstrate minimal mucosal thickening in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Acute cerebral infarction and microinfarcts involving a small portion of the right MCA territory (small portions of the right centrum semiovale, a short segment of the lateral aspect of the right precentral gyrus and a couple punctate foci along the right insular cortex and right subcentral lobule).2.SWI imaging raises the question of persistent occlusion at an M3 branch of the right MCA associated with adjacent hypoxia.3.Microhemorrhage along the corpus callosum.4.Old lacunar infarcts along the right thalamus and right caudate nucleus.5.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. This has mildly progressed since 2004.6.Possible occlusion of the intracranial RVA which is diminutive. Based on the prior exams and this exam this appears long standing.