Progressive weakness of right hand. MRI: There is a punctate focus of mildly restricted diffusion in the right superior frontal gyrus subcortical white matter. There is a background of diffuse cerebral white matter and small areas of encephalomalacia in the right pons, right corona radiata, and left basal ganglia. There is no evidence of acute intracranial hemorrhage or mass. There is a partially empty sella. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There appears to be secretions and mucosal thickening in the bilateral maxillary sinuses.MRA: The exam is partly degraded by patient motion. There is a paucity of flow related enhancement in the distal right PCOM and proximal right PCA. There is no evidence of significant steno-occlusive lesions in the rest of the proximal cerebral arteries. There is apparent mild focal dilatation of the proximal right PICA and diminished flow related enhancement just distal to this. Otherwise, there is no evidence of cerebral aneurysms.
1. Suggestion of a punctate recent infarct in the right superior frontal gyrus subcortical white matter.2. Probable diffuse chronic white matter small vessel ischemic disease and chronic lacunar infarcts in the right pons, right corona radiata, and left basal ganglia. 3. A paucity of flow related enhancement in the distal right PCOM and proximal right PCA may be secondary to significant steno-occlusive disease. 4. Apparent mild focal dilatation of the proximal right PICA and diminished flow related enhancement just distal to this.