Clinical question: With ischemic lesions. Signs and symptoms: Encephalopathy. Nonenhanced brain MRI:Diffusion weighted images demonstrate no evidence of a new foci of acute ischemic stroke since prior study. The right anterior frontal subcortical foci of acute ischemic stroke noted on prior MRI from 4 -- 1 -- 15 is less conspicuous on current study.Acute hemorrhage in the left anterior temporal lobe and the extension into the left basal ganglia, surrounding vasogenic edema and associated mass effect on the adjacent cortical sulci and the frontal horn of the left lateral ventricle demonstrate subtle interval decreased and change in signal intensity consistent with expected evolution of hematoma. Small amount of residual acute blood in dependent bilateral occipital horns demonstrate interval decreased. The ventricular system remain within normal size and is stable since prior exam. Although there is no evidence of new restricted diffusion the subcortical small vessel ischemic stroke in the right hemisphere demonstrates subtle interval increase since prior exam (axial flair 501 image 21).Extensive chronic lacunar infarcts of the pons and chronic right cerebellar ischemic strokes are again noted without change.
1.No detectable new acute ischemic stroke as is questioned clinically. Right frontal subcortical focus of restricted diffusion seen on prior exam is less conspicuous on current study.2.The left hemispheric hemorrhage demonstrate signal changes consistent with interval evolution and subtle decreased mass effect.3.Extensive chronic ischemic strokes in the periventricular and subcortical white matter, bilateral basal ganglia, pons and right cerebellum are again identified. Finding in the right hemispheric subcortical white matter appear more conspicuous on current exam without evidence of restricted diffusion.