Clinical impression: Rule out CVA. Signs and symptoms: Aphasia. Nonenhanced brain MRI:Severely limited exam due to extensive motion artifact which precludes detection of subtle findings.Diffusion-weighted images are diagnostic and demonstrate no evidence of an acute ischemic strokes.Examination demonstrates fairly extensive subcortical and periventricular flair hyperintensity of bilateral cerebral hemispheres consistent with advanced chronic and minimally hemorrhagic small vessel ischemic strokes. Extensive similar findings are also present in bilateral basal ganglia and thalami as well as pons.Images through posterior fossa demonstrate multiple small varying size chronic ischemic strokes primarily in the distribution of pica branches.In addition there is a large left MCA territory chronic nonhemorrhagic ischemic stroke extensively involving the left temporal and occipital lobes.Above findings results in an ex vacuo enlargement of cortical sulci and ventricular system consistent with parenchymal volume loss.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and calvarium.
1.No acute ischemic stroke.2.Very extensive chronic and minimally hemorrhagic ischemic strokes as detailed.3.Multiple small nonhemorrhagic cerebellar strokes and a large left MCA territory chronic ischemic stroke involving the left temporal and occipital lobes.4.Ventriculomegaly and prominence of cortical sulci as result of extensive chronic strokes as detailed.