Acute mental status change. Brain MRI:There are 2 high signal intensity lesions on diffusion-weighted imaging, one on the right precentral gyrus just around paracentral lobule and another one right posterior temporal lobe. The precentral gyrus lesion is more likely T2 shine through but the right posterior temporal lesion is likely represent acute or subacute ischemic infarct.There is no evidence of associated hemorrhagic transformation.Multifocal scattered high signal intensity lesions on FLAIR imaging on white matter and periventricular white matter including brain stem indicating either nonspecific small vessel disease or chronic ischemic lacunar infarcts.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.MRA head:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate slightly irregular but without evidence of significant luminal stenosis on narrowing on bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.There is no intracranial aneurysm.
1. Focal small acute ischemic infarction on the right posterior temporal lobe as described above (series 402, image 116/32).2. Extensive white matter changes indicating nonspecific small vessel disease and multifocal chronic lacunar infarctions involving brainstem and periventricular white matter.3. No evidence of major intracranial arterial occlusion or intracranial arterial aneurysm.