Diagnosis: Other malaise and fatigueClinical question: stroke, MS flare?Signs and Symptoms: left side weak There is a focus of diffusion restriction measuring approximately 6 mm in size located in the right centrum semiovale and subcortical white matter of the right precentral gyrus.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Many of these are perpendicularly oriented to the lateral ventricles. Additional T2 and FLAIR sequence high signal foci are present in the internal capsules and brainstem.Subdural effusions in the posterior fossa are likely related to atrophy.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.
1.There is a small focus of diffusion restriction in the subcortical white matter adjacent to the right precentral gyrus compatible with acute infarction.2.There are periventricular and subcortical white matter lesions as well as lesions in the internal capsules and brainstem present of a mild to moderate degree which are compatible with patient's clinical history of multiple sclerosis. Compared to the previous exam there is no significant change3.There is no evidence for acute demyelinating plaque.