Male, 53 years old, with altered mental status and oropharyngeal dysfunction. History of hemorrhagic medulla/pons stroke. No new lesions seen on CT. Susceptibility, T2 hyperintensity and T2 shine through artifact are seen within the medulla. The medulla is not edematous, and if anything, there appears to be a component of encephalomalacia. Patchy nonedematous T2 signal also continues into the upper cervical cord. Elsewhere in the brain, no restricted diffusion is seen. Numerous patchy foci of periventricular and subcortical T2 hyperintensity are demonstrated. No parenchymal edema or mass effect is detected. No abnormal extra-axial fluid collection is seen. Numerous scattered foci of susceptibility are evident within the brainstem and cerebellum, and to a lesser degree the cerebral hemispheres, compatible with chronic microhemorrhage. No acute intracranial hemorrhage is detected.The dura appears to be mildly and diffusely thickened. The marrow signal of the calvarium is uniformly more hypointense than what is typically seen. A mucous retention cyst is evident in the right maxillary sinus.
1.Findings in the medulla which would be compatible with the stated history of prior stroke in this area.2.Signal abnormality within the medulla and upper cervical cord is felt most likely to be chronic as there is no evidence of swelling or mass effect.3.Elsewhere in the brain, moderately extensive chronic small vessel ischemic disease is seen, but there are no suspected acute abnormalities.4.Diffuse mild thickening of the dura is of uncertain etiology. However, it may be reactive to changes in the overlying calvarium which demonstrates relatively hypointense marrow signal. This in turn is a nonspecific finding which can reflect normal variation as well as a variety of metabolic conditions such as chronic renal disease.