Petechial hemorrhagic transformation of MCA infarct

No acute intracranial hemorrhage. Ventricles and sulcal pattern are age appropriate. Basal cisterns are unremarkable.

Area of increased mean transit time (MTT) and normal cerebral blood flow in the right frontoparietal lobes is in keeping with an area of penumbra in the right middle cerebral artery territory.

There is a large region of cortical and subcortical T2 signal abnormality involving the right middle cerebral artery (MCA) territory, which shows diffusion restriction. This is in keeping with established infarction. There is relative sparing of the right prefrontal gyrus.

There is extensive gyriform susceptibility on the SWI sequence, slightly smaller than the infarction area, and predominantly involving the temporal lobe.

A large area of low density change in the right middle cerebral artery territory is demonstrated with prominent regions of gyriform and punctate foci of high density. No subarachnoid or extra-axial hemorrhage identified. Minimal mass-effect is exerted on the right lateral ventricle however the
midline remains central.

No new regions of ischemic change compared to the MRI. The focal low density within the left cerebellar hemisphere is again noted and unchanged from the previous imaging and is likely to represent a previous ischemic insult.