New left hand weakness. Rule out stroke. MRI: There is a small areas of cortical and subcortical diffusion restriction and T2 hyperintensity involving the postcentral gyrus, with minimal gyriform susceptibility effect. An additional punctate focus of susceptibility effect is present in the left thalamus without associated edema, which may represent focus of prior microhemorrhage. There are multiple foci of T2 hyperintensity involving the cerebral white-matter and punctate foci of encephalomalacia in the deep gray nuclei in addition to periventricular white-matter confluent T2 hyperintensity. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the paranasal sinuses.MRA: There is no evidence of significant steno-occlusive lesions. There appears to be mild narrowing of the anterior genu of the left cavernous internal carotid arteries and the mid left V4 segment. There is no evidence of saccular aneurysms.
1.Small acute right middle cerebral artery infarct, involving the precentral gyrus, with minimal susceptibility effect, which may represent prominent collateral blood flow or microhemorrhage, for example.2.Moderate chronic microvascular ischemia and multiple lacunar infarcts.3.No significant steno-occlusive lesions involving the large cerebral arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.