Female, 86 years old, with virtigo that woke the patient up from sleep, nystagmus, nausea and vomiting. Evaluate for brain stem stroke from posterior circulation No restricted diffusion is seen. There is, however, patchy and confluent periventricular T2 hyperintensity. Involvement of the subcortical white matter, basal ganglia, thalami, and the pons is also evident. No parenchymal mass effect or edema is seen. No intracranial hemorrhage or any other abnormal extra-axial fluid collection is seen. The ventricles and sulci are proportionately prominent compatible with volume loss.
1.No acute intracranial abnormality, and in particular, no evidence of acute ischemia.2.Moderately extensive chronic small vessel and lacunar ischemic disease.