Unsteadiness on feet [R26.81], Reason for Study: ^Reason: rule out stroke, metastatic disease History: 89yoF with remote large left MCA stroke with the residual milileft hemiparesis presenting with new right sided ataxia rendering her unable to ambulate There is a focal high signal intensity on diffusion-weighted imaging on the right temporo-occipital lobe which does not show definitive diffusion restriction but shows subtle high signal intensity on T2/FLAIR images. Constellation of findings indicate possible late subacute ischemic infarction.There is encephalomalacia on the left frontotemporal parietal lobe including left insular cortex indicating left MCA territorial chronic ischemic infarct, unchanged since prior scan.Scattered patchy T2/flair high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel ischemic disease, unchanged since prior scan.There is no evidence of acute hemorrhagic lesion.Significant metallic susceptibility artifacts on the left frontal area, unchanged. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Subtle high signal intensity on the right temporo-occipital lobe may indicate late subacute ischemic infarction.2. Chronic left MCA territorial ischemic infarction involving left frontal, parietal, temporal lobes and insular cortex, unchanged.3. Non specific small vessel ischemic disease, unchanged.