Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: please evaluate for stroke History: h/o meningioma sp resection, seizures, p/w acute onset aphasia given tPA Brain MRIThere are scattered restricted diffusion lesions involving left frontal operculum (frontal lobe) and insular cortex indicating acute ischemic stroke. Associated susceptibility lesions especially at subcortical white mater of anterior aspect of insular cortex suggest hemorrhagic transformation.There is focal tissue loss on the left frontal lobe which likely to be related to prior meningioma surgery.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal.The mastoid air cells are clear.There is a retention cyst on the right maxillary sinus. Both eye lenses are not seen indicating postoperative changes.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant (more than 50%) of luminal stenosis at the right MCA M1 segment.The left MCA and bilateral ACAs appear to be normal.Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate subtle luminal irregularities on bilateral carotid bulbs without evidence of luminal stenosis.Otherwise, there are normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Acute ischemic infarction involving left MCA territory, specifically left frontal lobe and insular cortex with focal hemorrhagic conversion.2. Significant (more than 50%) luminal stenosis of the right MCA M1 segment. Otherwise unremarkable intracranial arterial system.3. Subtle irregularities of bilateral carotid bulbs without evidence of luminal narrowing. Otherwise unremarkable extracranial craniofacial arterial system.