Male 62 years old with right-sided weakness and dysarthria, evaluate for acute stroke. There is a focus of of diffusion restriction within the periventricular white matter involving the corona radiata and posterior aspect of the caudate nucleus. No other foci of restricted diffusion. There are multiple foci of susceptibility within the pons and additional ones in the cerebellum and left temporal lobe. There is no evidence of intracranial mass. There is moderate subcortical and periventricular T2/FLAIR hyperintensity suggestive of chronic small vessel ischemic disease. There are chronic lacunar infarcts in the left thalmus and right dorsal pons. There is parenchymal volume loss which is slightly prominent for patient's age. There is no midline shift or herniation. No hydrocephalus. The major cerebral flow voids are intact aside from diminutive flow-related signal involving the right vertebral artery.Minimal paranasal sinus mucosal thickening and bilateral mastoid air cell opacification is noted. Left lens implant is in place.
1. Acute infarct involving the right corona radiata and posterior aspect of the caudate nucleus.2. Moderate chronic small vessel ischemic disease. Chronic left thalamic and right dorsal pontine lacunar infarcts.3. Multiple chronic microhemorrhages with a distribution predominantly suggesting a chronic hypertensive etiology.