Altered mental status [780.97], Reason for Study: ^Reason: subacute stroke vs malignancy History: subacute stroke vs malignancy Motion artifact degraded image quality.New low attenuation area (right inferior parietal lobule) found on prior CT scan does not show evidence of restricted diffusion. In addition, those areas show high signal intensity on T2-weighted images. Therefore, this lesion is more likely to be subacute or chronic ischemic stroke with the T2 shine through effect. The possibility of metastatic lesion with surrounding edema cannot be completely excluded due to lack of postcontrast enhancement scan. Since post Gad enhanced scans were not obtained, these scans should be repeated without additional charge to exclude any possibility of underlying abnormal enhancing lesion.Redemonstration of right occipital lobe encephalomalacia likely due to prior right PCA territorial infarct.There is no evidence of new ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable except extraocular changes of right lateral ventricle occipital horn. The gray-white matter differentiation is normal. 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal irregularity of intracranial arterial systems including bilateral MCAs as well as bilateral cavernous sinus segment of ICAs without evidence of significant (more than 50%) luminal stenosis. Distal right vertebral artery is not seen. No definitive intracranial arterial aneurysm is seen. For more precise vascular evaluation, CT angiography can be considered for further imaging study if clinically indicated.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuosity and irregularity were seen on bilateral carotid bifurcation area. Otherwise, bilateral common carotid arteries and left vertebral arteries were demonstrated without significant luminal stenosis.
1. Chronic ischemic infarction with right PCA territorial ischemic infarction2. Right inferior parietal lobe high signal intensity on T2 and FLAIR images without evidence of restricted diffusion, thus unlikely to be an acute ischemic infarction. No hemorrhagic transformation was seen.3. Atherosclerotic changes on both extracranial and intracranial arterial system. No definitive evidence of intracranial aneurysm. No evidence of significant (more than 50%) luminal stenosis.4. If indicated CTA of head can be considered for more precise vascular evaluation. 5. Since post Gad enhanced scans were not obtained, these scans should be repeated without additional charge to exclude any possibility of underlying abnormal enhancing lesion.