Clinical question: Rule out structural lesion or ischemia. Signs and symptoms: Right-sided weakness. Pre- and post enhanced brain MRI:Diffusion weighted images demonstrate well-demarcated focus of restricted diffusion in the left caudate head measuring at 16 x 17 mm in transaxial dimensions. Additional focus of restricted diffusion in the left paramedian pons measuring at 8 x 21 mm in transaxial dimensions and consistent with acute nonhemorrhagic ischemic strokes.Above findings are also well visualized on both FLAIR and T2-weighted images as foci of hyperintensity.Additionally examination demonstrate extensive periventricular and to a lesser degree subcortical foci of FLAIR hyperintensity consistent with moderate chronic small vessel ischemic strokes with resultant mild ex vacuo dilatation of lateral ventricles. Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses is normal and mid normal pattern of enhancement.Unremarkable calvarium, paranasal sinuses and mastoid air cells.Images through the orbits demonstrate a chronic blowout fracture of the floor of right orbit with evidence of retro-orbital fat herniation inferiorly of approximately 10 mm.
1.Acute ischemic stroke of the left caudate head and left paramedian pons as detailed/measured above.2.Extensive chronic small vessel ischemic strokes with resultant mild ex vacuo dilatation of lateral ventricles.3.No detectable abnormal enhancement.4.Chronic blowout fracture of the right orbital floor with 10 mm inferior herniation of retro-orbital fat.