 MRI BRAIN: There is a linear acute infarct involving the right centrum semiovale/coronal radiata. There is a punctate acute infarct in the left superior parietal lobule. There is an additional punctate acute infarct in the anterior right parahippocampal/fusiform gyrus. Tiny focus of hemorrhage seen in the right posterior frontal infarct. There is a 7 x 5 mm T2 hypointense old hemorrhage with susceptibility effect in the left middle cerebellar hemisphere on series 401 image 8. Additional scattered punctate foci of susceptibility effect are seen within the right and left frontal lobes.There is extensive periventricular and subcortical white matter T2 signal abnormality likely are presenting advanced chronic microvascular ischemic changes. There is an old right cerebellar hemisphere infarct with encephalomalacia. There is bilateral ethmoid and sphenoid sinus mucosal thickening with trace bilateral maxillary sinus mucosal thickening.MRA BRAIN: There is motion degradation of the source images somewhat limiting evaluation. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are grossly unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA NECK: There is mild motion artifact limiting evaluation. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of high grade stenosis (less than 50% by NASCET criteria bilaterally at the carotid bulbs). Both vertebral arteries are patent. There is limited visualization of the origins of the vertebral arteries due to artifact, however they appear grossly patent. The great vessel origins are otherwise intact.
1.Three small to punctate acute infarcts in the bilateral supratentorial brain as described above. Tiny focus of hemorrhage is also noted within the acute infarct in the right centrum semiovale.2.No flow limiting intracranial stenosis or aneurysm.3.No flow limiting stenosis in the neck.4.Multiple foci of susceptibility most compatible with chronic microhemorrhages, most prominent in the left middle cerebellar peduncle.5.Advanced chronic microvascular ischemic changes.Findings regarding acute infarcts were discussed with Dr. Cejas from Neurology over the telephone at 10:07 AM today.