Clinical question: Rule out ischemic stroke. Signs and symptoms: Left upper extremity numbness, condition the accompanied by left face and left lower extremity numbness. Nonenhanced brain MRI:Diffusion weighted images demonstrate a small subtle focus of restricted diffusion in the right posterior/inferior aspect of pons. Finding is not associated with any susceptibility signal change to suggest hemorrhage. Flair and T2 weighted images also also demonstrate this finding. In addition there is a focus of chronic corner infarct adjacent to this finding.Images through supratentorial space demonstrate extensive periventricular and to a lesser degree subcortical foci of flair hyperintensity highly suggestive of moderate chronic nonhemorrhagic small vessel ischemic strokes. Minimal similar findings in the right basal ganglia is also noted.There is no evidence of chronic cortical stroke.The ventricular system and cortical sulci remain within normal size and maintained midline.The signal voids of major intracranial branches are identified.Unremarkable calvarium, orbits and paranasal sinuses
1.Small subtle focus of restricted diffusion in the right posterior/inferior aspect of pons.2.Findings suggestive of moderate chronic nonhemorrhagic small vessel ischemic strokes and including chronic ischemic strokes of the pons.3.Unremarkable exam otherwise.