Presentation
Falls 2 days. Weak left side.
Patient Data
Cytotoxic edema of the right insular cortex and right inferior frontal gyrus, most in keeping with acute right MCA territory infarct, particularly with right anterior middle frontal gyrus encephalomalacia consistent with an old MCA infarct. Diffuse deep white matter chronic small vessel ischemic changes. No intracranial hemorrhage. Ventricles and sulci are prominent, in keeping with age related volume loss.
Left frontotemporal scalp superficial swelling. No calvarial or base of skull fracture. Osteopenia. Minor mucoperiosteal thickening in the left maxillary sinus.
Encephalomalacia of the right frontal lobe in the territory of the right middle cerebral artery is noted. This involves the pre and post central gyrus. There is marked periventricular, deep and subcortical white matter hypodensity, likely due with the chronic small vessel disease. It is difficult to exclude acute subcortical infarction within this setting.
Case Discussion
These two scans demonstrate the typical evolution of a subacute infarct into established encephalomalacia, in a patient with extensive small vessel ischemic change.
Unable to process the form. Check for errors and try again.