Clinical question: Ischemic stroke workup. Left lower extremity weakness with acute on chronic worsening of RUE and RLE weakness. Signs and symptoms: As above. Nonenhanced brain MRI:Diffusion weighted images demonstrate an acute nonhemorrhagic ischemic stroke in the distribution of the left lenticulostriate artery measuring approximately up to 5.5 x 13.5-mm.Additionally flair and T2-weighted images demonstrate moderate chronic small vessel ischemic strokes of bilateral subcortical and periventricular white matter as well as left bilateral basal ganglia, the thalamus and extensively of the pons. No evidence cerebral cortical chronic ischemic stroke is detected. Punctate foci of T2 hyperintensity in the right cerebellum is suspicious for a tiny chronic cerebellar stroke. Slight prominence of cortical sulci for age.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.
1.Acute nonhemorrhagic ischemic stroke in the distribution of left lenticulostriate artery measuring at 5.5 x 13.5-mm.2.Moderate chronic minimally small vessel ischemic strokes as detailed.