Clinical question: Evidence of new CVA. Signs and symptoms: Patient with history of ischemic CVA x 5, presents with some similar symptoms, initial CT of head is negative. Pre and post enhanced brain MRI:No evidence of acute intracranial process and in particular no detectable acute ischemic stroke is seen.There is a large area of encephalomalacia of the left cerebral hemisphere invaginating the left frontal, parietal and occipital lobes. There is resultant significant extra-axial dilatation of left lateral ventricle. Findings consistent with a large chronic ischemic stroke with minimal chronic hemorrhagic changes. There is resultant Wallerian degeneration.Patchy foci of periventricular flair hyperintensity in the right frontal suggestive of chronic small vessel ischemic strokes are noted. There is absence of signal void of the cavernous and supraclinoid left internal carotid artery consistent with complete occlusion. If further assessment is clinically been necessary CTA or MRA is recommended.Unremarkable calvarium and soft tissues of the scalp.Unremarkable paranasal sinuses and orbits.Extensive opacification of right mastoid air cells without convincing evidence of opacification of right middle ear cavity is noted.
1.No acute ischemic process.2.Extensive left hemispheric encephalomalacia consistent with a chronic minimally hemorrhagic stroke.3.Minimal chronic small vessel ischemic stroke.4.Absence of signal void of left cavernous and supraclinoid internal carotid consistent with occlusion.5.Extensive opacification of right mastoid air cells without opacification of right middle ear cavity similar to prior head CT.