Disturbance of skin sensation, gait problem, acute ischemic stroke. No evidence of acute ischemic or hemorrhagic lesion.Multifocal patch high signal intensities on periventricular white matter on FLAIR imaging indicate nonspecific small vessel ischemic disease. In particular, the lesion on the right posterior periventricular white matter showed susceptibility artifacts on the mesial aspect indicating prior ischemic lesion with hemorrhagic transformation.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Prominent nodular and linear enhancing structures were seen on the left caudate head (series 1101, images 17/31) and right internal capsule (series 1101, images 17/31)and right caudate head (series 1101, images 16/31) indicate prominent venous structure or small developmental venous anomaly.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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Moderate degree nonspecific small vessel ischemic disease.3. Possible chronic ischemic infarction with focal hemorrhagic transformation on the right periventricular white matter posterior aspect.4. Normal brain MRA. 