Clinical question: Stroke. Signs and symptoms: Right arm weakness and aphasia. Nonenhanced brain MRI:Diffusion weighted images demonstrate multiple small foci of restricted diffusion involving the cortex, subcortical and periventricular white matter of the left frontal lobe consistent with acute ischemic stroke without evidence of hemorrhage or mass effect or mass effect. This finding is also poorly appreciated on FLAIR and T2-weighted images. Note should be made that there is extensive motion artifact on FLAIR and T2 series.Additionally study demonstrate moderate to advanced chronic nonhemorrhagic small vessel ischemic strokes of bilateral subcortical and periventricular white matter and pons.There is a large focus of FLAIR/T2 hyperintensity in the left middle cerebellar peduncle with suggestion of mild increased volume. The finding measures approximately at 20 x 21 mm in transaxial dimensions (FLAIR series 601 image 8). The morphology and location of this finding is not highly suggestive of an ischemic change. This finding however demonstrate no significant change when compared to 2 prior head CTs including the exam from 11-26-12. Although relatively stable since 2012 follow-up with an enhanced imaging is recommended to exclude a mass.There is slight prominence of cortical sulci and supratentorial ventricular system with maintained midline.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Extensive chronic sinus disease similar to prior CT examination.Findings and concerns on this exam were discussed by radiology resident on-call Dr. Alexander Anup with neurology resident on call Issa Naoum # 9203 at the time of review of the exam.
1.Incomplete and suboptimal exam due to motion artifact.2.Small patchy foci of restricted diffusion in the left frontal cortex and subcortical-periventricular white matter consistent with acute nonhemorrhagic ischemic strokes.3.Moderate chronic nonhemorrhagic small vessel ischemic strokes is noted.4.A focus of FLAIR/T2 hyperintensity (20 x 21 mm) in the left middle cerebellar peduncle which has remained stable since 2012 head CT exam however follow-up with enhanced imaging is recommended to entirely exclude possibility of a mass.