Diagnosis: DysarthriaClinical question: STROKESigns and Symptoms: SLURRED SPEECH MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a focus of encephalomalacia present in the right gyrus rectus.There are periventricular white matter lesions which are bright on T2 and FLAIR MRI present of moderate degree.There are T2 and FLAIR hyperintense lesions in the basal ganglia and brainstem associated with some volume loss.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 demonstrate minor opacities in the left mastoid air cells. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.The right transverse sinus and sigmoid sinus are larger than the left transverse sinus and sigmoid sinus.
1.There are numerous small lesions in the brainstem and basal ganglia which are suspicious for old lacunar infarcts. There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.No evidence for dural venous sinus thrombosis