Diagnosis: Cerebral infarction, unspecifiedClinical question: eval for acute stroke codeSigns and Symptoms: L hemiplegia L hemisensory MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR signal hyperintense lesions are present in the left lateral aspect of the pons and lower midbrain as well as the lateral aspect of the left thalamusThe CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and 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.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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are similar in size.
1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.Lesions present in the left lower midbrain, left pons and left thalamus and posterior limb of the internal capsule are nonspecific but could be vascular related. Alternatively they could be related to demyelination.3.No evidence for intracranial cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.5.No evidence for acute ischemic cerebral infarction.