Evaluate for stroke and abscess in the setting of slurred speech and immunosuppression.History of prior ischemic infarct with right-sided weakness, presenting with progressive slurred speech for 3 months and subjective left sided weakness for past 6 days. There appears to be a small area of restricted diffusion in the anterior right pontomedullary junction. There is also scattered patchy T2 hyperintensity in the pons. There is also encephalomalacia in the bilateral basal ganglia with associated susceptibility effect that likely represents chronic hemorrhage. There are a few scattered foci of susceptibility effect in the bilateral cerebral hemispheres, as well. There is extensive patchy cerebral white matter T2 hyperintensity predominantly in a periventricular and deep white matter distribution. There is no evidence of abnormal intracranial fluid collections. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are a small amount of secretions in the left maxillary sinus. There is degenerative spondylosis at C3-4 with a posterior disc-osteophyte that impinges upon the spinal cord.
1. Apparent small recent, perhaps subacute, infarct in the anterior right pontomedullary junction superimposed upon chronic pontine and bilateral basal ganglia infarcts and microhemorrhages.2. Extensive white matter abnormality may represent chronic small vessel ischemic disease or HIV encephalopathy, or a combination thereof, for example.3. Degenerative spondylosis at C3-4 with a posterior disc-osteophyte that impinges upon the spinal cord. Dedicated cervical spine imaging may be considered for further evaluation if clinically warranted.4. No evidence of acute infarct or intracranial abscess. 