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MRI Brain Infarct

Comparison: CT of the head from an outside facility dated []. Techniques: Obtained on a 1.5 Tesla magnet. 1. MRI brain without contrast: Sagittal T1, axial T2 FLAIR, axial susceptibility-weighted, and axial diffusion weighted/ADC images. 2. MRA of the vertebrobasilar and internal carotid circulation from the skull base through the vertex. 3D MIP reconstructions provided. 3. MRA of the carotid bifurcation with 3D MIP reconstructions. Findings: BRAIN: There is a 3.6 x 1.9 cm geographic region of restricted diffusion with corresponding low ADC signal seen in the left frontal cortex in the watershed distribution of the MCA. Multiple additional punctate foci of diffusion restriction are seen within the left occipital lobe (Series 3, Images 10-13). These are likely representative of acute infarcts involving variable distal branches of the PCA. There is a right holohemispheric, curvilinear region of high T1 and T2 signal, consistent with a chronic subdural hematoma, 2 cm. Curvilinear high T1 and T2 signal is also seen in the left posterior parietal region, consistent with a smaller subdural hematoma, 5 mm. Serpiginous low T1 and T2 signal with surrounding increased T2 signal is seen in the region of the right operculum, consistent with encephalomalacia secondary to an chronic stroke with reactive gliosis. There is no midline shift, intracranial mass, ventriculomegaly, or suggestion of herniation. Polypoid mucosal thickening is noted in the right maxillary sinus. MRA COW: The distal internal carotid arteries are normal in caliber and signal intensity. There is truncation of the portion of the right middle cerebral artery, consistent with previous infarct. The left MCA is normal in appearance. The distal vertebral arteries are nearly symmetric and terminate in a normal basilar artery and posterior fossa branches. There is no aneurysm, flow-limiting disease, or evidence to suggest vascular malformation. MRA Carotid Bifurcations: Normal signal is demonstrated in the distal segment of the common carotid arteries through the bifurcations. There is no evidence of aneurysm or dissection. IMPRESSION: 1. Findings consistent with acute infarcts involving the left MCA and PCA distributions as described above. These likely represent embolic events. 2. Bilateral chronic subdural hematomas, right greater than left. 3. Partial truncation of the right MCA with right operculum encephalomalacia changes, consistent with an old infarct.