MRI
Axial T1
Coronal T1
Axial T2
Axial FLAIR
Axial DWI
Findings:
- A large right fronto-parietal and anterior temporal cortical and subcortical area of high T2 signal intensity with restricted diffusion demonstrating high DWI signal. Associated cytotoxic brain edema is seen with effacement of the related cortical sulci, mild compression of the left lateral ventricle and slight contralateral midline shift.
- A left fronto-parietal deep white matter patchy area of high T2/FLAIR signal with slight exvacuuo-dilatation of the left lateral ventricle. The left cerebral hemisphere appears relatively small sized. Patchy peri-ventricular white matter areas of bright T2/FLAIR signals are noted.
- Axial T2 images shows attenuation of the distal ICA on either side.
- No hydrocephalic changes.
- Normal posterior fossa.
- Left mastoiditis with opacification and T2 prolongation is incidentally noted.
Conclusion:
A large right fronto-parietal and anterior temporal area of restricted diffusion with cytotoxic brain edema; representing acute infarction.
Left high fronto-parietal old infarction and periventricular leukomalacia with consequent reduction of the left cerebral hemisphere.
- The recurrent bilateral cerebral infarctions and the possible attenuation of the distal ICA could suggest idiopathic progressive arteriopathy of childhood or Moyamoya disease; for MSCT or MR cerebral angiography.