Weakness [R53.1] / Other specified disorders of muscle [M62.89] / Slurred speech [R47.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke History: Right facial droop dysarthria Brain MRIThere is focal restricted diffusion on the left internal capsule posterior rim indicating acute ischemic stroke.There is no evidence of hemorrhagic lesion.Multifocal encephalomalacia involving left parieto-temporo-occipital lobes, right cerebellar hemisphere, bilateral frontal lobes (left more than right), left basal ganglia and left thalamus are seen indicating chronic ischemic infarction. The left midbrain and pons show Wallerian degeneration.Susceptibility lesions on bilateral parietal lobes associated with encephalomalacia lesions described above indicating chronic hemorrhages likely related to prior ischemic stroke.The ventricles, sulci and cisterns are symmetric and show exvacuo changes, but overall unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly irregular but normal ICAs, MCAs, ACAs and vertebrobasilar system. No arterial occlusion. No aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous but normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Left internal capsule posterior limb acute ischemic stroke without evidence of hemorrhagic conversion.2. Multifocal chronic ischemic infarctions with prior hemorrhagic conversion lesions as described above.3. No evidence of major intracranial or extracranial arterial occlusion or stenosis.4. No intracranial arterial aneurysm. 