Clinical question: History of thalamic stroke and subsequent thalamic pain syndrome and tremor; please include DWI sequence. Signs and symptoms: Preoperative planning for the DBS; include diffusion-weighted sequences. Pre- and post enhanced DBS surgical planning MRI: This is a limited exam and for purposes of surgical planning and is not a true diagnostic test.No evidence of restriction on diffusion weighted series.Axial 3-D T2 weighted images demonstrate a focus of T2 hyperintensity in the left thalamus consistent with encephalomalacia at the site of previously known infarct. Minimal susceptibility signal changes within this region consistent with prior chronic hemorrhage. The finding measures at least at 10 x 5 mm in transaxial dimensions. Additionally examination demonstrated scattered foci of T2 hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres suggestive of chronic small vessel ischemic strokes.Unremarkable cortical sulci and ventricular system and with widely patent CSF cisterns and maintained midline.Post enhanced images are severely degraded due to artifact however within this limitation there is no convincing evidence of abnormal enhancement.
1.Pre- and post enhanced surgical planning brain MRI exam as detailed above.2.Focus of chronic hemorrhagic left thalamic lacunar infarct is noted.3.Changes suggestive of chronic small vessel ischemic strokes.4.Severely degenerated post enhanced images without convincing evidence of abnormal enhancement.