 There is a punctate diffusion restriction in the midbrain, anterior to the aqueduct, in the region of the left oculomotor nerve nucleus and the left medial longitudinal fasciculus.This focus is consistent with acute ischemia.There are multiple T2/FLAIR hyperintensities in the cerebellum, in the pons, in the thalami, the right external capsule, and in the centrum semiovale. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are punctate focus of signal loss on susceptibility imaging in the left external capsule.Paranasal sinuses and mastoid air cells are clear.The flow-void of the left vertebral artery is not visualized, probably related to hypoplasia vs. Occlusion of the left vertebral artery.
1. Findings suggest lacunar infarction in the midbrain within the region of the left oculomotor nucleus and the left medial longitudinal fasciculus.2. Periventricular and subcortical white matter lesions of a moderate degree and lesions in the cerebellum, in the pons, in the thalami, and in the right external capsule are nonspecific. At this age they are most likely vascular related. There is associated with mild volume loss in the pons.3. Hypoplasia versus occlusion of the left vertebral artery.