Altered mental status, unspecified [R 41.82]64 years Male (DOB:2/9/1952)Reason: cva History: cvaPROVIDER/ATTENDING NAME: DANIEL W ROBINSON Brain MRIRestricted diffusion areas are seen on the right internal capsule posterior limb, right side midbrain as well as right cerebellar hemisphere indicating acute ischemic stroke without evidence of hemorrhagic conversion.There are encephalomalacia involving left inferior parietal lobule and superior and posterior temporal gyrus suggesting prior ischemic infarct. Focal increased signal intensity on diffusion-weighted imaging on the left inferior parietal lobule (series 3, image 25) does not show any definitive evidence of restricted diffusion and is associated with adjacent chronic ischemic infarct related gliotic changes. Therefore, this lesion is more likely representing T2 shine through artifacts.Another small lacunar infarct is seen on the right inferior parietal lobule.Scattered patchy T2/FLAIR high signal intensity lesions on centrum semiovale indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear. Redemonstration of right medial orbital wall fracture deformity, unchanged since prior scan.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate 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. Acute ischemic infarct without evidence of hemorrhagic conversion involving right internal capsule posterior limb, right side midbrain, and right cerebellar hemisphere.2. Chronic ischemic infarction involving left inferior parietal lobule and posterior superior temporal gyrus.3. Nonspecific small vessel ischemic disease, unchanged.4. No evidence of flow-limiting arterial luminal stenosis on both intracranial and extracranial arterial system. No aneurysm is seen.