69 years Male (DOB:3/9/1946)Reason: Eval for acute infarct in R internal capsule vs pons History: L face/arm/Leg weaknessPROVIDER/ATTENDING NAME: ROBERT A MULLIKEN CHRISTOPHER M GOMEZ There is a new focus of diffusion restriction present in the right pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Small foci of T2 hyperintensity are present in the right internal capsule, right basal ganglia and thalami bilaterally. These were also present on the prior exam. There are patchy foci of T2 and FLAIR signal hyperintensity in the brainstem. The right cerebral peduncle is low but smaller than the left cerebral peduncle. There is signal hyperintensity within the right cerebral peduncle on T2 and FLAIR MR imaging.Susceptibility imaging is degraded by motion artifact as are many of the pulse sequences. There are punctate signal hypointensity is redemonstrated in the left middle cerebellar peduncle. In isolation these are of unknown clinical significance.No abnormal mass lesions are appreciated intracranially.Normal vascular flow voids are present in the distal left 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 right internal carotid artery flow-void is not readily visualized. This is a finding also present on the prior exam.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits demonstrate elongation the AP dimension of the right eye. The lens of the left eye is thin.
1.Findings are compatible with an acute right pontine lacunar infarct.2.Findings are compatible with old lacunar infarcts in the right basal ganglia, thalami and brainstem.3.Findings are suggestive of occlusion of the right internal carotid artery.4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Right eye staphyloma.6.The examination is degraded by patient motion which can obscure more subtle abnormalities.