Slurred speech and weakness. MRI: There is periventricular and subcortical white matter T2 hyperintensity and there is an area of encephalomalacia in the right superior frontal gyrus. There is a nonspecific punctate focus of susceptibility effect in the left frontal lobe white matter, which may represent a chronic microhemorrhage. There are mildly prominent perivascular spaces in the right inferior basal ganglia. There is no evidence of intracranial mass or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a left lens implant.MRA: There may be minimal narrowing of the proximal left posterior cerebral artery. Otherwise, there is no evidence of significant steno-occlusive lesions or aneurysms.
1. Probable chronic small vessel ischemic cerebral white matter disease and chronic infarct in the right superior frontal gyrus, but no evidence of acute infarct.2. Perhaps minimal narrowing of the proximal left posterior cerebral artery. Otherwise, no evidence of significant steno-occlusive lesions involving the other proximal cerebral arteries.