Reason: concern for CVA, unable to further assess chronicity on CT History: ams, contracted MRI of the brainThere is encephalomalacia present along the left parietal lobe as well as in the watershed zone between left anterior and middle cerebral artery territories. There is associated susceptibility effect along the left parietal lobe.There is flair and T2 signal change along the medial aspect of the left parietal lobe as well as the adjacent left and right gyrus along the posterior aspects . There are punctate foci of susceptibility present along the cortex of these structures . Associated increase in diffusion weighted imaging signal along these territories is not accompanied by loss of signal on ADC maps.There are several punctate foci of increased signal on diffusion weighted imaging in the subcortical white matter of the right frontal lobe medially that are associated with flair signal hyperintensity. One of these appears to be associated with diffusion restriction on the ADC map.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium-sized there. The posterior communicating arteries are identified and are very small. The vertebral arteries are similar in size. The left posterior inferior cerebellar artery is extracranial origin.The exam is mildly compromised by patient motion.
1.Findings suggest late subacute infarction along the medial aspect of the left parietal lobe and in the posterior aspects of the cingulate gyrus bilaterally.2.Encephalomalacia is present along the left parietal lobe and watershed zone between the left middle and anterior cerebral artery territories.3.Punctate lesions in the subcortical white matter of the right medial frontal lobe are present which are suspected to be vascular related. One of these may represent a more acute punctate focus of infarction.4.No evidence for intracranial aneurysm.