 There is a punctate focus of diffusion restriction in the right external capsule compatible with an acute ischemic infarct. No mass effect or midline shift. There are additional foci of T2/FLAIR hyperintensity in the bilateral basal ganglia and left thalamus without diffusion restriction, likely representing old lacunar infarcts. There is T2/FLAIR hyperintensity in the pons, in addition to a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions on FLAIR and T2 images. There is a punctate focus of signal loss on susceptibility imaging in the left corona radiata, which most likely represents a punctate focus of microhemorrhage. In isolation, this is of limited clinical significance.There is no evidence of intracranial hemorrhage, extra-axial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are normal in position. Flow-voids are present within the major vessels indicating patency. Trace mucosal thickening of the ethmoid air cells and scattered opacification of the right mastoid air cells. The visualized paranasal sinuses and mastoid air cells are otherwise clear. Calvarium and extracranial soft tissues are grossly unremarkable.
1. Punctate focus of diffusion restriction in the right external capsule is compatible with acute ischemic infarction. No mass effect or midline shift.2. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 