Clinical question: Evaluate for stroke. Signs and symptoms: Dysarthria and aphasia. Nonenhanced brain MRI:There is no detectable acute intracranial process and diffusion-weighted images are negative.Examination redemonstrates extensive patchy and confluent foci of FLAIR hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres, minimally in bilateral basal ganglia and moderate the in the pons and minimally in bilateral cerebral hemispheres without detectable change since prior study. Findings are consistent with chronic nonhemorrhagic small vessel ischemic strokes. Similar to prior exam there is a punctate focus of susceptibility in the left paramedian lower pons representing a punctate focus of chronic hemorrhage.Extra-axial dilatation of lateral ventricles similar to prior exam and with maintained midline. Prominence of cortical sulci are stated age similar to prior study.Signal void of major intracranial arterial branches are identified.Calvarium and soft tissues of the scalp as well as the orbits and paranasal sinuses are unremarkable.
1.No acute intracranial process and no evidence of diffusion weighted abnormalities.2.Stable extensive findings of small vessel ischemic strokes since prior exam as detailed.3.Prominence of cortical sulci and supratentorial ventricular system for patient's stated age similar to prior exam.