Left-sided hemiplegia, alteration of sensation. There is no evidence of acute ischemic lesion on this scan.However, previously recognized bilateral basal ganglia high signal intensities on FLAIR images have been expanded.Specifically, the right basal ganglia and anterior aspect of the thalamus lesion has been expanded downward to the level of the right side midbrain. In addition, on the right basal ganglia likely at the globus pallidus, there is signal void on SWI images indicating possible hemorrhages.The left side globus pallidus and anterior thalamus lesion does not show significant interval change since prior exam.On Gad enhanced images, there is a bit patchy enhancement on the right basal ganglia lesion which may represent focal inflammation or local Gad leakage due to hemorrhages.Significant interval change of the extent of the right side lesion within relatively short period of time and patchy enhancement pattern suggest possibility of venous congestive encephalopathy with possible hemorrhages or infectious/inflammatory lesion. Possibility of tumorous condition is unlikely. And there is no evidence of arterial ischemic infarction.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.
1. Progressed right basal ganglia and thalamus FLAIR high signal intensity lesion which now has expanded toward the right midbrain and upper pons with possible hemorrhages. Diagnostic possibilities include venous congestive encephalopathy or infection/inflammatory lesion. Tumorous condition is unlikely. Clinical correlation is indicated and considering diagnostic angiography is suggested to exclude underlying vascular lesions including dural arteriovenous shunts on venous congestive encephalopathy. This was discussed with Dr.Brorson at the time of this dictation.2. No evidence acute ischemic infarction on this scan.