Acute onset left upper extremity and lower extremity weakness. Clinical suspicion of internal capsule/pontine infarct. There are 2 small diffusion restriction lesions along the right frontal corona radiata, which correlates with T1-hypointense, T2-hyperintense signal. The largest measures up to 1.3 cm and extends toward the external capsule. These are compatible with acute/recent infarcts. There is a ring shaped diffusion weighted hyperintensity in the left frontal white-matter with no definite associated ADC abnormality which is equivocal for recent ischemia.In addition, there are multiple small chronic infarcts in the cerebral and brainstem white-matter, deep gray nuclei, and cerebellum as well as confluent and patchy T2-hyperintense signal in the cerebral and brainstem white-matter, which is nonspecific but likely chronic microvascular ischemia. There is no significant mass-effect, midline shift, or brain herniation. There is no acute hemorrhage. Punctate susceptibility effect in the superior aspect of the right thalamus may represent mineralization or chronic blood products. The ventricles and other CSF-containing spaces are mildly enlarged, reflective of mild global brain volume loss. The major vascular flow voids are preserved. The skull, scalp and orbits are grossly unremarkable. There is mild ethmoid mucosal thickening.
1.Two areas of diffusion restriction along the right corona radiata are compatible with acute/recent white-matter infarcts. A third lesions in the left frontal lobe is associated with ring-shaped diffusion weighted hyperintensity no remarkable ADC restriction and is equivocal for recent ischemia, versus chronic ischemia.2.Otherwise, findings of chronic microvascular ischemia and small chronic infarcts are present throughout the brain.