TIA: Right hand weakness, dysarthria. MRI: There are several punctate foci of restricted diffusion and high T2 signal in the bilateral cerebral hemispheres, including in the left precentral gyrus hand region and right posterior temporal and occipital lobes. There is diffuse cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution. There is also a punctate area of encephalomalacia in the right corpus callosum body. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull is grossly unremarkable. There are bilateral lens implants. There is a right scalp lipoma that measures up to 12 mm in thickness.MRA: There is no evidence of significant steno-occlusive lesions in the head and neck arteries. The right vertebral artery is hypoplastic. There is no evidence of cerebral aneurysm.
1. Acute punctate infarcts in the bilateral cerebral hemispheres, including the left precentral gyrus hand region. Diffuse cerebral white matter T2 hyperintensity, predominantly in a periventricular distribution may represent chronic small vessel ischemic disease and probable chronic infarct in the right corpus callosum.2. No evidence of significant steno-occlusive lesions in the head and neck arteries. 