 There are multiple foci of restricted diffusion in the left cerebral hemisphere predominantly involving the deep white matter of the left frontal lobe with additional foci in the left frontal, parietal, and left temporal lobes. Few foci of restricted diffusion within the left frontoparietal cortex are also seen. There is also restricted diffusion involving the left caudate head and anterior putamen. Compared to recent outside MRI, there are new foci of restricted diffusion involving the left frontal centrum semiovale as well as the left temporal subcortical white matterThere is FLAIR hyperintensity corresponding to the recent infarcts. No evidence of hemorrhagic conversion. There is also minimal additional nonspecific scattered T2/FLAIR hyperintensity involving the right parietal lobe. There is no significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. There is mild scattered paranasal sinus opacification on the particularly the left maxillary sinus and right posterior ethmoid sinuses. Calvarium and extracranial soft tissues are grossly unremarkable.MRA HEAD
1. Multiple acute to early subacute infarcts in the left cerebral hemisphere. There are multiple new infarcts since prior MRI from 12/2/2016 including the left frontoparietal centrum semiovale and the subcortical left temporal white matter.2. High-grade stenosis/short segment occlusion involving the left ICA terminus and proximal left M1 segment similar to prior CTA. There is a small plaque involving the left ICA origin without hemodynamically significant stenosis.3. There is near occlusion of the right vertebral artery with minimal flow in the cervical segment better seen on recent CTA. There is also small amount of flow involving the right intracranial distal vertebral artery which may be retrograde. 4. Additional mild to moderate multifocal stenoses include the bilateral cavernous and supraclinoid internal carotid arteries and focal high-grade stenosis involving the right proximal A1 segment. 