Diagnosis: Syncope and collapseClinical question: r/o acute ischemiaSigns and Symptoms: dysarthria, right sided weakness There is diffusion restriction involving the right inferior parietal lobule, portions of the precentral gyrus, the midportion and posterior aspect of the right superior and middle temporal gyri as well as the posterior half of the right insular cortex and a small patchy area of the right frontal lobe centered in the precentral gyrus in an area measuring 24x74mm axial dimensions.There is encephalomalacia present in the left middle frontal gyrus.There is encephalomalacia involving the central portions of the right SCA territory of the right cerebellar hemisphere.There is cerebellar atrophy presentThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are foci of T2 hyperintensity in the pons and thalami.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.Images are degraded due to artifacts related to patient motion.
1.Acute infarction involving the right MCA territory as detailed above.2.Encephalomalacia is present in the left frontal lobe and right cerebellar hemisphere as detailed above.3.Cerebellar atrophy.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Lesions in the pons and thalami of a moderate degree are likely related to old lacunar infarcts.6.Images are degraded due to artifacts related to patient motion. This may obscure more subtle abnormalities.