Altered mental status. The left temporal lobe and left parietal lobe inferior lobe shows encephalomalacia seen indicating chronic ischemic infarct.In addition, there are gyriform restricted diffusion areas especially posterior aspect of left temporal lobe indicate subacute ischemic infarct.There is no evidence of hemorrhagic transformation.There is no evidence of surrounding edema.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate nonvisualization of left MCA M1 segment indicating possible occlusion. Right MCA M1 segment as well as vertebrobasilar system show multifocal irregularity of intracranial arteries indicating atherosclerotic changes. The basilar artery is not seen on MRA, suggesting possible occlusion or severe stenosis, however, this could be an artifactual due to patient's motion. Therefore, for further evaluation, CT angiography is recommended if clinical indicated. 3D MRA neck TOF images with maximum intensity projections of the cervical vasculature demonstrate significant (probably more than 70%) stenosis of the left extracranial ICA just above the bifurcation. Distal to the stenosis, the left ICA luminal diameter appears to be smaller than that of the right side indicating possible long standing low flow through the cervical segment of the left ICA.The right CCA, bifurcation and extracranial right ICA appear to be normal.
1. Chronic ischemic infarction with encephalomalacia on the left temporo-parietal lobe with posterior temporal subacute ischemic infarction. There is no hemorrhagic transformation.2. The left MCA M1 segment appears to be occluded.3. The basilar artery is not seen on TOF MRA, this may indicate severe stenosis or occlusion but also could be related to artifacts. Head and neck CTA is recommended for further imaging evaluation.4. Significant luminal stenosis on the left extracranial ICA just above the bifurcation, CTA of neck or Carotid Doppler is recommended for more precise stenosis evaluation. 5. Atherosclerotic changes of intra and extracranial arterial system. 