Clinical question: R/O acute stroke. Signes and symptoms: Aphasis. Pre and post enhanced brain MRI:No evidence of acute intracranial finding including acute ischemic stroke.There is very extensive confluent foci of flair/T2 hyperintensity in the periventricular and subcortical white matter of the cerebral hemispheres, bilateral basal ganglia ( L> R ), thalami and the pons. Findings represent advanced chronic small vessel ischemic disease. There is resultant ex vacuo dilatation of the supratentorial ventricular system and prominent of the cortical sulci. Small chronic cortical stroke in right posterior parietal is also noted.Susceptibility MRI images demonstrate multiple small foci of microhemorrhages in the subcortical and periventricular white matter of cerebral hemispheres. The signal void of the major intracranial vasculature is identified.No abnormal enhancement of brain parenchyma, leptomeninges, calvarium, scalp or the orbits.Unremarkable calvarium, scalp, orbits, paranasal sinuses and the mastoids air cells.
1.No acute intracranial finding.2.Advanced chronic small vessel ischemic strokes, some with evidence of chronic hemorrhage.3.Small chronic right posterior parietal cortical stroke.4.No abnormal enhancement.