Clinical question: Evaluate for ischemia. Signs and symptoms: Right facial droop and right-sided weakness. Nonenhanced brain MRI:Examination demonstrates a large focus of restricted diffusion in the left upper pons measuring at 9 x 18-mm in transaxial dimensions. Finding is consistent with an acute nonhemorrhagic lacunar infarct.In addition the examination demonstrate extensive periventricular and subcortical confluent foci of flair/T2 hyperintensity with resultant ex vacuo dilatation of lateral ventricles consistent with extensive chronic nonhemorrhagic small vessel ischemic strokes. Similar signal changes in bilateral thalami and minimally in bilateral basal ganglial is also noted. Additional chronic pontine lacunar infarct on the right and in the right aspect of cerebellum and right middle cerebellar peduncle are present. Similar signal change in the left middle cerebellar peduncle is also detected.There is prominence of cortical sulci and ventricular system for patient's stated age and suggestive of underlying volume loss secondary to advanced small vessel ischemic strokes.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses is within normal. Calvarium and soft tissues of the scalp as well as orbits, paranasal sinuses and mastoid air cells are unremarkable. Mild left maxillary sinusitis however is noted.
1.Acute lacunar infarct in the left paramedian pons 9 x 18-mm.2.Extensive supratentorial and infratentorial chronic nonhemorrhagic small vessel ischemic strokes as detailed.