Clinical question: Stroke, Rule out acute ischemia. Signs and symptoms: Speech difficulty. Nonenhanced brain MRI:There is no detectable acute intracranial process in particular no evidence of acute stroke is seen.Examination however demonstrate patchy and confluent foci of FLAIR/T2 hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres and minimally in the basal ganglia without associated susceptibility signal changes likely representing chronic small vessel ischemic strokes of mild to moderate degree.Slight prominence of supratentorial ventricular system suggestive of underlying parenchymal volume loss likely secondary to small vessel ischemic strokes.No detectable cortical signal abnormality, unremarkable cerebral cortical sulci and CSF spaces.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Calvarium and soft tissues of the scalp are unremarkable.Extensive opacification of right mastoid air cells without signal abnormality of the right middle ear cavity is noted of questionable clinical significance.
1.No acute intracranial process.2.Mild to moderate chronic nonhemorrhagic small vessel ischemic strokes in the supratentorial brain parenchyma as detailed.