Stroke. History of endocarditis. BRAIN MRI:The study is mildly to moderately limited by motion.In addition to the large right parieto-occipital and the smaller right thalamic/mesial temporal as well as the left posterior temporal infarcts, there are multiple smaller infarcts involving both cerebral and cerebellar hemispheres. The infarcts are associated with susceptibility effect, which probably reflects the presence of hemorrhage. The infarcts show peripheral contrast enhancement and surrounding edema and mass-effect. The larger infarcts show a gyriform pattern of contrast enhancement while the smaller infarcts show ring-like contrast enhancement with prominent central diffusion restriction, especially within the frontal lobes. These findings are suggestive of evolution of the infarcts and perhaps cerebritis towards the formation of abscesses. The right parieto-occipital and right thalamic/medial temporal infarcts are associated with abnormal contrast enhancement along the lining of the adjacent posterior right lateral ventricle, which may reflect additional early ventriculitis. Besides compression of the posterior right lateral ventricle by the adjacent infarcts, the ventricular system is normal in size. There is only very minimal midline shift at the level of the third ventricle. There is no herniation. There is fluid in the sphenoid sinuses and mild mucosal thickening in the paranasal sinuses. Right retinal detachment with subretinal hemorrhagic effusion are not grossly changed since the previous CT scan. Minimal vitreous hemorrhage is likely present as well.CRANIAL MRA:The study is at least moderately limited by patient motion. There is attenuation of the distal right posterior cerebral artery and its branches without abrupt cut off, which may relate to the right parieto-occipital infarct. The left A1 segment is also is attenuated, which can be congenital. The major intracranial vessels are otherwise grossly patent. There is no definite large aneurysm but small aneurysms cannot be ruled out given the study limitation by motion.NECK MRA:Accounting for the study limitations, there is no significant, flow-limiting stenosis or gross dilatation of the cervical carotid and vertebral arteries.
1.Mild-to-moderate study limitation caused by motion.2.Evolution of the embolic multifocal cerebral and cerebellar infarcts with evidence of hemorrhage. The possibility that these represent septic embolic infarcts should be considered as the pattern of enhancement of many of the infarcts is somewhat unusual for bland infarction but can be seen in the setting of developing abscess and cerebritis.3.Attenuation of the right distal posterior cerebral artery and its branches, without abrupt cutoff, probably relate to the large right parieto-occipital infarct and the mass-effect. Cranial and neck MRAs are limited by motion artifact but show no significant stenosis, otherwise.4.Right retinal detachment with subretinal hemorrhagic effusion are not grossly changed since the previous CT scan. Minimal vitreous hemorrhage is likely present as well.