Clinical question: Evaluate for stroke, edema. Signs and symptoms: Worsened hypertension and bradycardia. Nonenhanced brain MRI:There is no detectable acute intracranial process and diffusion weighted images are negative.Extensive confluent periventricular and mildly subcortical nonspecific FLAIR hyperintensity of the white matter is noted. There is resultant mild ex vacuo dilatation of the lateral ventricles.Minimal similar signal changes in bilateral basal ganglia and pons is also noted. Findings are nonspecific however at this age group off and represent microvascular ischemic changes.No detectable cortical signal abnormality and unremarkable bilateral cerebellum and vermis.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.
1.No acute intracranial process and negative diffusion-weighted images.2.Extensive periventricular and to a lesser degree bilateral basal ganglia and pontine FLAIR hyperintensity suggestive of advanced chronic nonhemorrhagic small vessel ischemic strokes as detailed.