Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: r/o mass or new strokeSigns and Symptoms: period of unresponsiveness and shaking There is encephalomalacia involving the right middle cerebral artery territory including right frontal lobe and right parietal lobe and much of the superior temporal gyrus. There is also involvement of the right basal ganglia and insular cortex.There is redemonstration of a small focus of encephalomalacia in the right cuneus of the occipital lobe.There is atrophy of the right middle cerebral peduncle and signal change in the right brain stem compatible with Wallerian degenerationNo new focus of cerebral infarction is identified in the left hemisphere or posterior fossaThere are punctate foci of susceptibility present in the right thalamus and to a lesser degree left thalamus.There are punctate foci of signal loss on susceptibility imaging in the right middle cerebral artery territory infarction.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.
1.Encephalomalacia due to large right middle cerebral artery territory cerebral infarction now associated with a well-aerated degeneration.2.Remote right occipital lobe small infarct3.No evidence for acute cerebral infarction4.Thalamic microhemorrhages