Diagnosis: Slurred speechClinical question: Evaluate for strokeSigns and Symptoms: R-sided facial droop and slurred speech x15 mins, now resolved The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchymaThere are punctate foci of T2 and FLAIR signal hyperintensity present within the thalami, basal ganglia and pons.There is a small focus of encephalomalacia along the inferior aspect of the left occipital lobe along the lingual gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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. The eyeball lenses are thin.
1.There is no evidence for acute ischemic cerebral infarction.2.Multiple lesions within the basal ganglia, thalami and brainstem which are suspected to represent old lacunar infarcts3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 