Left sided stroke: Right hemiparesis. Brain MRI: There are areas of gyriform restricted diffusion and high T2 signal in the left parietal lobe adjacent to an underlying area of encephalomalacia, with associated cortical laminar necrosis and probable chronic microhemorrhages. There are also punctate foci of cortical and subcortical restricted diffusion and high T2 signal in the left frontal lobe. There is a background of mild scattered cerebral white matter T2 hyperintensity without restricted diffusion, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is lack of flow-related enhancement of the imaged portions of the left internal carotid artery. There is reconstitution of flow in the left middle and anterior cerebral arteries at the circle of WIllis. The right vertebral artery appears to terminate as the PICA. There is a fetal right PCOM. The other cerebral arteries are unremarkable and there is no evidence of saccular aneurysms. Neck MRA: There is lack of enhancement through the left internal carotid artery. There is mild narrowing of the origin of the right internal carotid artery. The right vertebral artery is diminutive. The other portions of the major cervical arteries are intact.
1. Acute areas of infarction involving the left parietal and frontal lobes, mainly in a watershed distribution superimposed upon a chronic left parietal lobe infarct. 2. Significant steno-occlusive disease at the origin of the left internal carotid artery. 