Sudden left-sided headache with gait instability. Assess for intracranial hemorrhage or structural abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is focal parenchymal loss with underlying T2 hyperintensity along the posterior aspect of the right inferior parietal lobule. There are also mild scattered punctate T2 hyperintensities in the frontoparietal white-matter and the pons are probably from chronic microvascular ischemia. The ventricles and sulci are mildly prominent due to cerebral volume loss. There is no midline shift or herniation. There is loss of the normal right internal carotid artery flow void intracranially. The right transverse and sigmoid sinuses are diminutive. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the left mastoid air cells.
1.No acute infarct, intracranial hemorrhage, or mass. 2.A small area of encephalomalacia in the right inferior parietal lobule likely represents a chronic infarct.3.Loss of the normal intracranial right internal carotid artery flow void may reflect significant proximal steno-occlusive disease. Dedicated head and neck vascular imaging is recommended for further evaluation.Dr. Monther Qandeel discussed the above findings and recommendations with Dr. Andrew Davis over the phone on the day of the examination at 1630 hours. 