Clinical question: Acute stroke? Signs and symptoms, acute ischemic stroke. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates mild scattered foci of FLAIR and T2 hyperintensity without associated susceptibility signal changes highly suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes. Findings are probably mainly in the subcortical and periventricular white matter and without detectable similar signal changes in the basal ganglia, thalami or pons. Unremarkable as cerebral cortex and cortical sulci as well as ventricular system and CSF spaces.Unremarkable orbits, paranasal sinuses, mastoid air cells and calvarium.Nonenhanced brain MRA:Bilateral internal carotid arteries are thickened and unremarkable through the skull base and in their supraclinoid segments.Bilateral anterior and middle cerebral arteries and their distal branches are unremarkable.Patent and unremarkable bilateral vertebral arteries, bilateral pedicle branches as well as basilar artery and distal branches.
1.No acute intracranial process.2.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter.3.Unremarkable nonenhanced brain MRA.