New infarction bordering a chronic infarct, in an 89-year-old patient

The axial FLAIR and FSE T2-weighted scans reveal extensive chronic deep white matter ischemia (with abnormal mild hyperintensity), together with generalized cortical atrophy and more focal atrophy in the left MCA posterior division, reflecting a prior chronic infarct. There is also abnormal high signal intensity adjacent to the largest area of cystic change, which could simply reflect gliosis due to this old infarct. However, the diffusion-weighted image demonstrates prominent abnormal high signal intensity (confirmed on the ADC map to be restricted diffusion) circumferential and medial to this region, consistent with an early subacute infarct (representing extension of the prior infarct).

New infarction bordering a chronic infarct
Part of the on-line supplement to Neuroradiology – The Essentials with MR and CT (© 2015)