Clinical question: Episodes of unresponsiveness. Signs and symptoms: Unresponsive intermittently. No focal findings on exam. Pre and postcontrast enhanced brain MRI:No detectable acute intracranial process and in particular no evidence of acute ischemic stroke is present.Examination demonstrate extensive periventricular and to a lesser degree subcortical confluent foci of FLAIR hyperintensity in bilateral cerebral hemispheres. Minimal similar signal changes are also present in bilateral basal ganglia and minimally in bilateral thalami and pons without evidence of hemorrhagic changes. Findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of moderate degree. There is slight prominence of lateral ventricles likely within normal range and possibly partially secondary to extensive chronic small vessel ischemic stroke. There is no deviation of midline. Unremarkable cerebral cortex and cerebellum/vermis.There is no detectable abnormal parenchymal or left meningeal enhancement.The signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses remain within normal and the normal pattern of enhancement.Unremarkable calvarium and orbits without abnormal enhancement.
1.No acute intracranial process.2.Chronic nonhemorrhagic small vessel ischemic strokes of moderate degree as detailed.3.Unremarkable pre and post enhanced brain MRI otherwise for stated age of 93.