46 years, Female, with acute onset of confusion. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are small foci of diffusion restriction in the left hippocampus, the left occipital lobe near midline, and in the mesial temporal lobe. These findings are consistent with acute to subacute infarct involving the posterior circulation. Of note, the basilar artery is uniformly small secondary prominent posterior communicating arteries.The previously described small stroke in the posterior limb of the right internal capsule and in the left mesial temporal lobe are redemonstrated. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections. Flow voids are present within the major vessels indicating patency.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age.Sella and orbits are grossly within normal limits. Bilateral mucosal thickening of the maxillary sinuses, sphenoid sinuses, and right greater than left paranasal mucosal thickening. There is slight leftward deviation of the nasal septum with a left bony spur. From the, bilateral mucus is visualized in the ethmoid sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.
1. No evidence of intracranial hemorrhage or mass.2. New areas of diffusion restriction in the left hippocampus, left mesial temporal lobe, and left occipital lobe consistent with acute/subacute ischemia.3. Redemonstration of previously described infarcts in the right posterior limb of the internal capsule and mesial left temporal lobe.