Patient presenting with new hypoattenuation in right side of the brain on recent CT, evaluate for acute vs subacute stroke. There are areas of mild diffusion abnormality along the peripheral right frontal lobe involving the right frontal operculum and insula. These areas correspond to foci of high ADC signal or isointense ADC signal, suggestive of chronic and subacute components of infarction. Mild areas of associated volume loss is compatible with encephalomalacia. Punctate focus of subacute infarcts are also noted in the right precentral gyrus as well as right superior parietal lobule. Additionally, there are areas of cortical T1 hyperintensity along the right frontal lobe and parietal lobe, consistent with cortical laminar necrosis related to prior ischemic injury. There are also areas of minimal punctate foci of periventricular T2/FLAIR hyperintensities which are nonspecific but are suggestive of very mild chronic microvascular ischemic changes. There is no evidence of acute intracranial hemorrhage, mass, or mass effect. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal opacification of the left sphenoid sinus and right mastoid air cells
Multiple infarcts in the right middle cerebral artery territory with signal features compatible with areas of subacute as well as chronic infarcts. No clear evidence of an acute infarct.