Left sided weakness. Disorientation, unspecified [R41.0], Eval for thromboembolic stroke. Limited examination was performed to evaluate for acute ischemia. The examination is also limited by motion artifact.There is encephalomalacia in the right occipital lobe in the region of previously identified right posterior cerebral artery territory ischemia. There is a small new area of diffusion restriction and likely FLAIR hyperintensity in the right occipital pole as well as a punctate area of diffusion restriction in the left thalamus, also with FLAIR hyperintensity. In addition, there is a cortical patchy diffusion signal with isointense signal on ADC maps present within the right greater than left splenium of the corpus callosum. There is suggestion of equivocal increased FLAIR signal within this area as well. Multiple scattered foci of FLAIR hyperintensity are demonstrated in the periventricular and subcortical white matter. Patchy FLAIR signal is again seen within the pons. There is no midline shift or mass effect appreciated. No definite gross intra-axial or extra-axial fluid collections are visualized.
1. Limited MRI of the brain demonstrates small area of acute to subacute ischemia in the right occipital pole as well as a punctate area of acute to subacute ischemia in the left thalamus.2. There is a equivocal diffusion restriction involving the right greater than left splenium of the corpus callosum which may relate to early ischemia.2. Right PCA territory encephalomalacia.3. Periventricular and subcortical white matter as well as brainstem T2/FLAIR signal abnormality likely relates to chronic microvascular ischemic change and appears similar to prior examination.