Female, 66 years old, altered mental status and history of epilepsy.Additional history obtained from the electronic medical record: PMHx of epilepsy (partial complex seizures), previous R MCA ischemic stroke with L side weakness with residual deficit, presenting with encephalopathy and dysarthria over the last 2 days. MRI brain: There are extensive patchy areas of restricted diffusion, compatible with acute infarct in the right anterior inferior frontal lobe, right superior frontal lobe, left posterior frontal lobe and left anterior parietal lobe, including the lateral left pre and post central gyri. There is T2/FLAIR signal abnormality in these regions. Additionally, there is high T1 signal in the anterior frontal lobe gyri, which may be related to petechial hemorrhage or mineralization. There is no large intraparenchymal hemorrhage.Large areas of encephalomalacia are redemonstrated in the right frontal and parietal lobes, as well as the right caudate and periventricular white matter, which is again compatible with chronic infarct. Associated ex vacuo dilatation of the right lateral ventricle is again noted. The ventricles are stable in size. There is evidence of chronic hemosiderin staining in the region of right frontal lobe infarct. Wallerian degeneration of the right cerebral peduncle is also again noted. Small chronic infarcts are redemonstrated in the right cerebellar hemisphere and right paramedian pons.Moderate abnormal T2/hyperintense signal in the periventricular and subcortical white matter is a non-specific finding which most commonly represents age-indeterminate small vessel ischemic disease. There is no extra-axial fluid collection, midline shift or herniation. No gross intracranial mass is identified. The major vascular intracranial flow voids are preserved at the skull base, compatible with gross patency. The paranasal sinuses and mastoid air cells are grossly clear.MRA neck: Postcontrast MRA images are nondiagnostic due to patient motion and difficulty with bolus delivery. A noncontrast time-of-flight MRA sequence was attempted. This, however, is also corrected by artifact and not reliable for interpretation.
1. Findings compatible with acute infarcts in the bilateral frontal lobes and left anterior parietal lobe. Suggestion of petechial hemorrhage or cortical laminar necrosis in the right frontal infarct region without gross hemorrhagic conversion. 2. Large chronic infarcts in the right cerebral hemisphere and multiple small infarcts in the right cerebellar hemisphere and pons are redemonstrated.3. Nondiagnostic MRA of the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.