Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: evaluate for stroke History: aphasia, weakness. Per chart, patient has a history of posterior fossa AVM and clipping of PICA aneurysm, also history of intraventricular hemorrhage. No evidence of acute ischemia or hemorrhage. No evidence of intracranial mass or mass effect. There is global parenchymal volume loss similar to prior. Again seen are remote postsurgical changes of suboccipital craniectomy and encephalomalacia involving the bilateral medial cerebellar hemispheres and vermis, particularly on the left. Metallic susceptibility artifact is demonstrated in the surgical bed. There is encephalomalacia involving the right superior frontal gyrus as seen before. There is also evidence of prior right anterior parietal burr hole. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific but compatible with mild chronic small vessel ischemic disease. Unchanged ventricular prominence particularly the anterior aspects of the lateral ventricles which is at least predominantly on an ex vacuo basis. No clear evidence of hydrocephalus. There is moderate opacification of the right maxillary sinus similar to prior. Bilateral lens implants are noted.
1. No evidence of acute ischemia.2. Posterior fossa postsurgical changes and extensive encephalomalacia involving the cerebellar vermis and medial aspects of the cerebellar hemispheres, particularly on the left. No significant change.3. Encephalomalacia involving the right frontal lobe also again seen. Mild chronic small vessel ischemic disease.