Clinical question: Rule-out CVA. Signs and symptoms: Not bilateral carotid stenosis, intermittent left photophobia, reports are left hand weakness PTA. Nonenhanced brain MRI:Diffusion-weighted images demonstrate no evidence of an acute ischemic stroke.Flair and T2 weighted images diffuse tiny foci of hyperintensity in the subcortical and to a lesser degree third ventricle right matter of cerebral hemispheres which in proper clinical setting could represent chronic small vessel ischemic strokes. There are no detectable similar lesion and the rest of the brain parenchyma. Bilateral basal ganglia, thalami, pons and cerebellum demonstrate normal signal intensity and morphology.The signal voids of major intracranial arterial branches are identified.Images through the orbits demonstrate a dislocated right lens lying in the dorsal aspect of the globe as well as noted on prior studies.Unremarkable calvarium and soft tissues of the scalp. Unremarkable paranasal sinuses and mastoid air cells.
1.No acute ischemic stroke.2.Findings suggestive of mild chronic small vessel ischemic strokes only in the subcortical and periventricular white matter of cerebral hemispheres.3.Dislocated right lens.4.Unremarkable nonenhanced brain MRI otherwise.