In case you’re interested (and even if you’re not), here’s the detailed info about the stroke.  The doctors said that my mother in-law has atrial fibrillation (had it for a long time), which is a type of irregular heartbeat.  In this case, when the heart does not beat or pump properly, blood can pool within the heart resulting in the formation of blood clots, which can travel to the brain causing a stroke.  The doctors believe the clot formed in the right medial cerebral artery (click here for more details about the artery):

• Supplies most of the temporal lobe, anterolateral frontal lobe, and parietal lobe.
• Perforating branches supply the posterior limb of the internal capsule, part of the head and body of the caudate and globus pallidus.
• Unilateral occlusion of Middle Cerebral Arteries at the stem (proximal M1 segment) results in:
  • Contralateral hemiplegia affecting face, arm, and leg (lesser).
  • Homonymous hemianopia – Ipsilateral head/eye deviation.
  • If on left: global aphasia.
• Usually occlusion is embolic in nature – thrombotic occlusion more common in carotids.

Now for detailed report of MRI (without contrast):

Stroke indication: Fall. Altered mental state. The patient was in atrial fibrillation.  Confusion and memory loss.

Technique: Multispin and multiplanar MR images of the brain.

Findings: Abnormal diffusion weighted signal is seen within the right basal ganglia and right MCA distribution extending to the temporal lobe concerning for right MCA infarct.

Prominence of the lateral ventricles, sulci, and basal cisterns is consistent with age related atrophy.  Increased signal within the periventricular white matter is consistent with small vessel gliosis of a chronic nature.

No mass, mass effect, nor extraaxial fluid collections are seen.  The basal cisterns remain intact and uneffaced.  The paranasal sinuses and orbits appear normal.

CONCLUSION:  Acute right MCA infarct.  Age related atrophy.  Chronic small vessel periventricular gliosis is noted as well.

= = =

Now the harder decisions.

Do we pursue any sort of physical therapy for her, knowing that her chance for another stroke, the “big one,” increases by the day?

Do we simply provide her comfort care for the rest of her life, going down the path of hospice-based assistance, assuming she might not live another six months, giving her whatever she wants even if it increases her chance of dying any moment (e.g., letting her drink as much water and eat as much food as she wants although she might choke on the intake)?

As usual, we’ll keep feeding her quiet, gentle sense of humour, which she has nurtured on even the most trying days of her life.