Clinical question: Evaluate for ischemia. Signs and symptoms: Right facial droop of right leg weakness. Nonenhanced brain MRI:Examination demonstrates small focus of restricted diffusion in the right lateral aspect of medulla measuring at 11.7 times 7-mm. No evidence of hemorrhagic changes or any appreciable mass effect.Examination in addition demonstrate extensive chronic strokes in the vertebral vascular system and including total PCA territory chronic stroke as well as multiple small bilateral cerebellar ischemic strokes and several chronic nonhemorrhagic pontine lacunar infarct.Images through supratentorial space in addition demonstrate findings of mild to moderate small vessel ischemic strokes in the subcortical and periventricular white matter of cerebral hemispheres.Midline is maintained and the cortical sulci appear normal for patient stated age.Signal void the major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells as well as calvarium and soft tissues of the scalp.
1.Focus of restricted diffusion in the right lateral medulla measuring at 7 times 11.7-mm.2.several chronic bilateral cerebellar ischemic stroke as well as large chronic nonhemorrhagic ischemic stroke involving the entire left PCA territory.3.Findings consistent with mild to moderate chronic nonhemorrhagic small vessel ischemic strokes.