Clinical question: Recent hemorrhagic infarct in left basal ganglia/thalamus, new weakness on left side. Signs and symptoms: New weakness on left. Nonenhanced brain MRI:Diffusion weighted images demonstrate multiple punctate size foci of apparent restricted diffusion in the subcortical and periventricular white matter of bilateral cerebral hemispheres. None of the findings however demonstrate corresponding ADC map signal change to confirm presence of an acute ischemic stroke. Findings likely T2 shine through from patient's extensive small vessel ischemic stroke.Acute hematoma in the left thalamus and the surrounding vasogenic edema results in mass effect on the third ventricle without appreciable deviation of midline. There is no significant change in the overall appearance of this finding and its mass effect since prior exam.In addition examination demonstrate numerous periventricular and subcortical as well as basal ganglia foci of flair hyperintensity highly suggestive of chronic small vessel ischemic strokes. Several of the small vessel ischemic strokes demonstrate internal chronic hemorrhage.No evidence of ventriculomegaly and CSF cisterns remain patent.The signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. Note however is made of a chronic retention cysts in the left maxillary sinus. Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column.Foramen magnum is unremarkable.C2- C3 demonstrate mild degenerative changes, moderate left neural foraminal compromise and unremarkable otherwiseC3 -- C4 demonstrate moderate degenerative changes of facets and ligamentum flavum and mild disk disease. Constellation of changes results in significant left and moderate right neural foraminal compromise and mild central spinal stenosis.C4 -- C5 demonstrate moderate disk disease and bilateral uncovertebral hypertrophy, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in significant (left greater than right) neural foraminal compromise and mild to moderate central spinal stenosis.C5 -- C6 demonstrate moderate disk disease, asymmetric right-sided uncovertebral hypertrophy and right-sided ventral hypertrophy spur and mild facet and ligamentum flavum hypertrophy. Constellation of changes results in mild central spinal stenosis, significant right neural foraminal compromise and moderate left.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild right greater than left uncovertebral hypertrophy and mild bilateral facet and ligamentum flavum degenerative changes. There is resultant moderate bilateral neural foramina compromise and mild central spinal stenosis.C7 -- T1 demonstrate minimal right neural foramina compromise and unremarkable otherwise.Examination at T1 -- T2 and T2 -- T3 levels are unremarkable.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord.Limited view of paraspinal soft tissues demonstrate no abnormalities.
1.Nonenhanced brain MRI demonstrate no convincing evidence of an acute ischemic stroke ( see above comments). Extensive chronic small vessel ischemic strokes with few demonstrating hemorrhagic changes. Stable left thalamic acute hemorrhage, surrounding edema and subtle mass effect without midline shift since prior head CT examination.2.Nonenhanced MRI of the cervical spine demonstrate no detectable cord caliber or signal abnormality. Extensive degenerative changes of cervical spine results in multilevel mild to moderate central spinal stenosis as well as multilevel neural foraminal compromise (some significantly) as detailed per level. 