Clinical question: Rule out stroke. Signs and symptoms: Slurred speech. Nonenhanced brain MRI:No detectable acute intracranial process and negative diffusion weighted series.Large focus of encephalomalacia extensively involving the right frontal, right basal ganglia and right anterior parietal lobe consistent with a large chronic ischemic stroke with resultant ex vacuo dilatation of the right lateral ventricle is noted.Minimal periventricular and subcortical foci of FLAIR hyperintensity consistent with mild chronic small vessel ischemic strokes are noted.Unremarkable intracranial contents otherwise.Signal void of major intracranial arterial branches are identified.Images through posterior fossa demonstrate a focus of encephalomalacia in the inferior aspect of right cerebellum with mild bulge of CSF signal in density at this site through a bony defect in the right paramedian occipital which is identical to prior head CT exam from 2013.
1.No acute intracranial process and negative diffusion weighted images.2.Large chronic right MCA territory ischemic stroke and minimal chronic small vessel ischemic strokes.3.Stable right median small right occipital calvarial defect and an underlying right cerebellar focus of encephalomalacia since prior head CT exam from 2013.