 Again seen is restricted diffusion involving the right paramedian frontal lobe including the posterior aspect of the superior frontal gyrus extending into the medial aspect of the precentral gyrus as well as portions of the right cingulate gyrus. There is associated T2/FLAIR hyperintensity as seen on MRI dated 12/1/2016. Susceptibility-weighted sequence demonstrates no evidence of hemorrhage within the areas of the acute infarct. As seen on earlier study from 12/1/2016 there is moderate degree of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which is nonspecific but compatible with moderate chronic small vessel ischemic disease. There is volume loss along the left caudate head and anterior body with susceptibility compatible with chronic infarct with mineralization or hemosiderin deposition. There is no hydrocephalus. No extra-axial collections. Bone marrow signal and extracranial soft tissues are grossly unremarkable.MRA HEAD
1. Earlier brain MRI study from 12/1/2016 was incomplete and patient returned for additional sequences. Again demonstrated are multiple acute infarcts in the right paramedian frontal lobe in the distal right ACA territory including the medial aspect of the right precentral gyrus.2. Moderate chronic small vessel ischemic disease with chronic lacunar infarct involving the left caudate head.3. MRA head demonstrates abrupt occlusion of the right anterior cerebral artery at the distal A2 segment.4. The right distal intracranial vertebral artery is not clearly seen and may be partially related to hypoplasia. There is however flow related enhancement just adjacent to the mid to lower basilar artery on the right suggestive of a residual stump, possibly related to an occluded distal right vertebral artery. CTA head and neck can be considered for further delineation of the posterior circulation.