Diagnosis: Cerebral infarction, unspecifiedClinical question: subacute cvaSigns and Symptoms: cva, ams MRI of the brainThere is a focus of diffusion restriction present along the inferomedial aspect of the left cerebellar hemisphere measuring approximately 37 x 30 mm in axial dimensions. It is bright on T2 and FLAIR.. There is an additional punctate focus of diffusion restriction present in the left occipital lobe along the left cuneus. There is volume loss associated T2 and FLAIR signal change along the anteromedial and inferior aspects of the frontal lobes bilaterally involving the anterior aspects of the gyrus rectus and adjacent orbital gyri. There is more involvement on the right side than the left. There is some associated susceptibility effect present. These represent foci of encephalomalacia.A small focus of susceptibility effect is present adjacent to the aqueduct.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are partially opacified. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not readily identified on this exam.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The left A1 segment is smaller than the right A1 segment. The posterior communicating arteries are not readily identified.
1.Subacute infarct involving the posterior, inferior and medial aspect of the left cerebellar hemisphere.2.Microinfarct involving the left occipital lobe in the cuneus.3.A small focus of encephalomalacia is present along the right cerebellar hemisphere. One possibility is that this is related to an old focus of infarction4.Small foci of encephalomalacia are present involving the medial right orbital gyrus and gyrus rectus and to a lesser degree left gyrus rectus and a small portion of the adjacent left orbital gyrus. Its location could suggest prior trauma. Please correlate clinical history.5.The left vertebral artery is not identified on small occlusion of the left vertebral artery.