Female, 65 years old, with left-sided face, arm and leg weakness and numbness. Evaluate for acute stroke. Numerous scattered small foci of restricted diffusion are seen within the paramedian right frontal lobe and along the right cingulate gyrus. No evidence of restricted diffusion is seen elsewhere in the brain.Elsewhere in the brain, numerous areas of patchy periventricular T2 hyperintensity are seen in both cerebral hemispheres. This is most conspicuous along the left frontal horn. There are also numerous scattered chronic lacunar infarcts in both basal ganglia with a large chronic hemosiderin stained infarct on the left.No evidence of significant generalized mass effect is seen. No abnormal extra-axial fluid collection or acute intracranial hemorrhage is suspected. Scattered punctate foci of susceptibility are seen in both cerebral hemispheres and the pons likely indicating chronic microhemorrhage. The left lateral ventricle is larger than the right which probably represents some degree of ex vacuo dilatation due to prior ischemic lesions. Ventricular morphology is otherwise unremarkable.On MR imaging of the head, no evidence of any significant vascular stenosis or occlusion is seen in the proximal circle of Willis vessels. The right callosomarginal artery is of small caliber and the right pericallosal artery is not distinctly visualized. There may be some scattered areas of mild to moderate vascular narrowing in the MCA distributions. No aneurysm is suspected.MR imaging of the neck reveals conventional aortic branching. The origins of the great vessels are patent. No significant vascular stenosis is detected in the carotid or vertebral vessels of the neck. Both common carotid arteries take a retropharyngeal course.
1.Scattered patchy areas of acute ischemia involving the right paramedian frontal lobe and cingulate gyrus.2.Evidence of extensive background chronic microvascular and lacunar ischemic disease.3.The right callosomarginal artery is not visualized and the right pericallosal artery is of small caliber. These findings may correlate to the right paramedian ischemic lesions.4.No significant vascular abnormalities in the neck.