54 years, Male, prior CVA with symptoms and might be new. Unsteadiness on feet There is restricted diffusion consistent with acute infarct involving the left paramedian aspect of the pons. No additional acute infarcts are appreciated. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic disease. Again seen are multiple chronic lacunar infarcts in the frontal periventricular white matter, with minimal ex vacuo dilatation of the anterior body of the left lateral ventricle. Also again seen are multiple chronic lacunar infarcts involving the bilateral cerebellar hemispheres as well as the right aspect of the midbrain along the cerebral peduncle. Also again seen are foci of susceptibility compatible with chronic microhemorrhages involving the bilateral cerebellar hemispheres as well as the right posterior inferior temporal gyrus.The ventricles and sulci are prominent, consistent with mild-moderate parenchymal volume loss and slightly advanced for age. No evidence of intracranial mass or mass effect. No midline shift or herniation. Major flow-voids are grossly preserved. There is minimal scattered paranasal sinus mucosal thickening. There is nonspecific T1 marrow signal hypointensity without discrete destructive lesions. Extracranial soft tissues are otherwise unremarkable.
1. Acute infarct involving the left aspect of the pons.2. Moderate chronic small vessel ischemic disease. Multiple supra- and infratentorial lacunar infarcts again seen. Multiple foci of chronic microhemorrhages are also again seen.