77-year-old female with right facial droop and expressive aphasia status post code stroke, tPA given for presumed ischemic stroke. There are areas of restricted diffusion involving the left frontal lobe including the lateral aspect of the precentral gyrus and extending into the left insula and operculum. There is no intracranial hemorrhage, focal mass effect, midline shift, herniation, or extra-axial fluid collection.There is additional moderate periventricular and subcortical white matter hypoattenuation which is nonspecific. Additional small areas of probable prior infarct include the left occipital region and right thalamus.The ventricles and basal cisterns are normal in size and configuration. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Acute infarct involving the left frontal lobe including the lateral aspect of the precentral gyrus and extending into the left insula and operculum.2.No evidence of intracranial hemorrhage or mass effect.3.Moderate chronic likely small vessel ischemic disease.