Altered mental status. Ischemic stroke on CT scan. The study is limited by patient motion.There is a relatively large area of diffusion restriction involving the left frontal, temporal, and parietal lobes as well as the lateral aspect of the basal ganglia. This is associated with mild swelling closing the respective sulci and mildly compressing the left lateral ventricle associated with minimal midline shift but no brain herniation. Along the superior edge of the acute infarct, there are foci of susceptibility effect and minimal cortical contrast enhancement. This infarct is associated with apparent loss of the flow void in the left M1 segment and attenuation of the left MCA sylvian branches. However, this study is not optimized for arterial assessment.Right parietal encephalomalacia from chronic infarct as well as moderate-to-severe chronic microvascular ischemia of the cerebral white-matter remain unchanged since the previous CT scan. Encephalomalacia also involves the posteromedial aspect of the cerebellar hemispheres, deep to the suboccipital craniectomy. Mild brain volume loss has not changed also. Orbits are notable for changes of bilateral eye lens replacement. There is trace mucosal thickening in the ethmoid sinuses.
1.Examination is limited by patient motion.2.Fairly large acute left MCA territory infarct with foci of petechial hemorrhage along its superior margin but no discrete hematoma to suggest frank hemorrhagic conversion. Mild local mass effect associated with the infarct.3.Right parietal chronic infarct, moderate-to-severe chronic microvascular ischemia of the cerebral white-matter and mild brain volume loss remain unchanged.4.Suboccipital craniectomy with underlying cerebellar encephalomalacia are also unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.