Clinical question: Stroke versus seizure. Signs and symptoms: Left facial droop. Nonenhanced brain MRI:No acute intracranial process and negative diffusion-weighted images.There are moderate primarily periventricular and minimally subcortical foci of FLAIR hyperintensity in bilateral cerebral hemispheres which are nonspecific however considering patient's stated age of 77 this appearance is often represent small vessel ischemic strokes. The anatomical morphology and signal intensity of brain parenchyma is otherwise unremarkable on FLAIR and T2-weighted sequences. The susceptibility MR sequence however demonstrate several bilateral parenchymal punctate foci of susceptibility consistent with chronic microhemorrhages. These findings do not correspond with the regions of small vessel ischemic strokes.The cortical sulci, ventricular system and CSF spaces are within normal for age.The signal void of major intracranial arterial branches are identified.Calvarium is intact. There is soft tissue thickening and hemorrhage of the right frontal scalp without underlying bony abnormality and likely representing posttraumatic finding as was noted on prior CT.All paranasal sinuses, bilateral mastoid air cells and middle ear cavities demonstrate normal signal intensity.
1.No acute intracranial process and negative diffusion-weighted images.2.Findings consistent with moderate chronic nonhemorrhagic small vessel ischemic strokes primarily in the periventricular and minimally in the subcortical white matter.3.Several punctate foci of susceptibility representing chronic microhemorrhages in bilateral cerebral hemispheres which are not in the small vessel ischemic strokes.4.Right frontal scalp edema and hemorrhage. Unremarkable calvarium, paranasal sinuses and mastoid air cells.