Evaluate for ischemia, etiology of R sided weakness and numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a non-enhancing 9x38mm axial dimension well circumscribed lesion located at the left putamen which is low signal on T1 and FLAIR imaging and high signal on T2 with associated susceptibility effect along its periphery and to a lesser degree centrally.There is an 8mm non-enhancing lesion present in the right periventricular white matter of the right frontal lobe. It is centrally low signal on T1 and FLAIR and high signal on T2 but peripherally high signal on T2 and FLAIR and low signal on T1. There is minimal susceptibility effect associated with it.There is an 8 x 3mm lesion in the subcortical white matter of the insular cortex adjacent to the anterior limb of the sylvian fissure. This is associated with susceptibility effect and low signal on T2, T1 and FLAIR.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and left vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is abnormal luminal signal in the right vertebral artery which may represent narrowing of this vessel.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Findings suggest a large evolving left putamen hematoma now in the early chronic stage as well as a smaller more chronic stage hematoma in the right insular subcortical white matter.2.A right frontal lobe periventricular white matter lesion is likely vascular related 3.Findings suggest luminal compromise of the intracranial right vertebral artery. If clinically appropriate an angiographic study (MRA or CTA) may help further assess this.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related. 