59 years Female (DOB:10/9/1956)Reason: Pt with complaints of diplopia on extreme right gaze; transient events of dizziness History: see abovePROVIDER/ATTENDING NAME: TAO XIE TAO XIE MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate T2 and FLAIR hyperintense foci are present in the brainstem. These are stable and compared to the prior exam.A punctate T2 and FLAIR hyperintense lesion is present in the right cerebellar hemisphere measuring approximately 7 mm in diameter. This could represent an old lacunar infarct.No foci of diffusion restriction are present in the brain parenchyma.There are multiple punctate subcortical foci of susceptibility effect identified on susceptibility imaging. There is also a punctate focus of susceptibility present within the midbrain. Several foci of susceptibility effect are present in the cerebellar hemispheres.No abnormal enhancing mass lesions are appreciated within the brain parenchyma. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal 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 visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a mottled appearance to the marrow of the visualized osseous structures.MRI orbits:The eyeballs are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact . There is asymmetry in the size of the cavernous sinuses with the right being slightly larger than the left especially along its posterior aspect. This is nonspecific and likely simply reflects anatomic variant.
1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is a mild degree of microhemorrhages distributed in predominantly subcortical white matter and also brainstem and cerebellum which do not have a specific pattern of distribution.4.Findings are compatible with old lacunar infarct in the right cerebellar hemisphere.5.There is no evidence for an orbital mass6.No intracranial lesion is identified which can explain the patient's diplopia on extreme right gaze. Perhaps it is below the threshold of detection on the current exam.