Female, 77 years old, with altered mental status. Please note that this is a limited evaluation including diffusion weighted images, susceptibility weighted images and MRA only.A large region of restricted diffusion is seen affecting most of the left ACA and MCA territory including the frontal and parietal lobes, to a lesser degree the temporal lobe, the basal ganglia and insula. A few very small foci of restricted diffusion are seen scattered through the right cerebral hemisphere as well.Mild generalized left cerebral mass effect is seen with sulcal effacement and slight effacement of the left lateral ventricle. No frank brain herniation is seen at this time. Mild susceptibility effect within the left basal ganglia is seen which could be artifactual or which could represent minimal petechial blood product. No frank parenchymal hematoma is seen.On MRA imaging, absence of flow related signal is seen in its expected location of the left ICA, ACA and MCA vessels. The right ICA demonstrates mild atherosclerotic irregularity through the cavernous segment. No definite high-grade stenosis is seen within the right ACA or MCA distribution. The vertebro-basilar system also appears to be free of high-grade stenosis.
1.Large acute stroke involving much of the left ACA and MCA territories. Very small acute infarcts are also seen scattered through the right cerebral hemisphere.2.Absence of flow related signal seen within the left ICA, ACA and MCA compatible with upstream occlusion.