Clinical question: Evaluate cause of left facial heaviness. Signs and symptoms: History of the left Bell's palsy, now with worsening left facial heaviness. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrate normal anatomical morphology of brain parenchyma.There are a few punctate foci of flair hyperintensity in the subcortical white matter of the bilateral cerebral hemispheres only. Although nonspecific this appearance could represent minimal chronic non-hemorrhagic small vessel ischemic strokes. The signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. Unremarkable cerebral cortex, cortical parenchyma ventricular system spaces and brain myelination. Negative post enhanced images or any abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits without evidence of abnormal enhancement. Unremarkable images through the paranasal sinuses and mastoid air cells.Dedicated thin pre-and post enhanced images through posterior fossa for cranial nerve evaluation demonstrate no evidence of abnormality. Bilateral facial nerves demonstrate normal signal intensity and with symmetrical mild expected enhancement.
1.No acute intracranial process.2.Minimal chronic nonhemorrhagic small vessel ischemic strokes and unremarkable exam otherwise.