Diagnosis: Cerebral infarction, unspecifiedClinical question: Eval extent of strokeSigns and Symptoms: RLE weakness, Wernicke's aphasia The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a small (6mm) focus of diffusion restriction along the left superior temporal gyrus. There is a signal hyperintensity present in an adjacent MCA distal M2 segment branch. There is lower signal in the adjacent venous structures including transmedullary veins and a cortical vein.There are several punctate foci of susceptibility effect present in the thalami and basal ganglia with a couple additional foci in the cerebellar hemispheres.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are punctate T2/FLAIR foci of signal hyperintensity present in the external capsules. An irregular focus of T2 signal hyperintensity and FLAIR hyperintensity is present in the pons. A few similar foci are present in the basal ganglia and thalami.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate minor opacities in the right ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.There is a small focus of infarction along the left superior temporal gyrus which could in part explain the patient's symptoms of Wernicke's aphasia. There are findings which suggest that there may very well be an occluded m2 branch responsible for this (image 100 series #401) associated with signs suggestive of local hypoxia.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Old lacunar infarcts are present in the basal ganglia, thalami and brainstem4.A few microhemorrhages in the thalami, basal ganglia and cerebellum are present which could relate to hypertension.