Clinical question: Right-sided numbness, poorly controlled hypertension concerning for TIA/stroke. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrates a focus of restricted diffusion in the left thalamus measuring at 4 x 10 mm in transaxial dimensions and consistent with an acute nonhemorrhagic lacunar infarct.FLAIR and T2-weighted images demonstrate several punctate foci of hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and including above mentioned acute lacunar infarct. Findings are consistent with small vessel ischemic changes of mild degree. There is no detectable cortical signal abnormality and images through the basal ganglia, pons and cerebellar hemispheres remain within normal on all MRI sequences. The cortical sulci, ventricular system as well as the CSF spaces remain within normal for stated age. Signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells.
1.Acute nonhemorrhagic left thalamic lacunar infarct measuring 4 x 10 mm in transaxial dimensions.2.Mild chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter as detailed.3.Unremarkable nonenhanced brain MRI otherwise.