Left upper extremity weakness, acute or subacute stroke. There are multifocal scattered restricted diffusion lesions involving bilateral frontal lobes, bilateral temporal occipital lobes and bilateral cerebellar hemispheres without evidence of hemorrhagic conversion.However, gradient-echo images which showed multifocal scattered signal void areas including bilateral thalamus and basal ganglia and brainstem indicating small chronic microhemorrhagic foci.On FLAIR imaging, there are patch high signal intensity lesions on bilateral periventricular white matter indicating underlying nonspecific small vessel ischemic disease.There is chronic ischemic infarct related encephalomalacia seen on the left PICA territory.38.8 mm x 10.9 mm sized midline frontal subgaleal lesion which show fat content signal intensity indicating subgaleal lipoma.The ventricles, sulci and cisterns are symmetric and unremarkable. 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.
1. Multiple bihemispheric, supra and infra tentorial acute ischemic infarctions without evidence of hemorrhagic transformation.2. Chronic ischemic infarction with encephalomalacia on the left cerebellar hemisphere, PICA territory.3. Extensive non specific small vessel ischemic disease.4. Multifocal scattered chronic microhemorrhagic foci.5. Midline frontal subgaleal lipoma, 38.8 mm x 10.9 mm.