Clinical question: Rule out stroke. Signs and symptoms: As above. Nonenhanced brain MRI:No evidence of acute ischemic stroke on diffusion weighted series.Examination demonstrates several small final flair hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres as well as minimally in the left basal ganglia. Although findings are nonspecific this appearance is often result of microvascular ischemic changes. This finding demonstrate no evidence of hemorrhagic component.The overall anatomical morphology as well as the signal intensity of brain parenchyma is otherwise within normal limits on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces for patient's stated age.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses is within normal.Images through the orbits are unremarkable.Paranasal sinuses and mastoid air cells remain well pneumatized.Nonenhanced brain MRA:Patent bilateral intracranial vertebral arteries and bilateral pica branches. Patent and unremarkable basilar artery, superior cerebellar and posterior cerebral arteries.Patent and unremarkable bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries and their branches are patent and unremarkable bilateral posterior communicating arteries.
1.Nonenhanced brain MRI demonstrate no evidence of an acute ischemic stroke. Findings of mild chronic small vessel ischemic strokes only in the subcortical and periventricular white matter and minimally in the left basal ganglia as detailed. Unremarkable exam otherwise.2.Unremarkable nonenhanced brain MRA.