Clinical question: Evaluate for lesion, hydrocephalus, review CT report from 9-18-15 signs and symptoms: Status post fall, generalized weakness and lethargy. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted images.As was noted on prior head CT this examination demonstrates fairly extensive periventricular and subcortical confluent FLAIR hyperintensity of white matter as well as large focus of cortical, subcortical and basal ganglia FLAIR hyperintensity involving extensively the left temporal and frontal lobes. Findings are believed to represent advanced chronic nonhemorrhagic small vessel ischemic strokes as well as a large left MCA territory chronic ischemic stroke. There is resultant ex vacuo dilatation of the lateral ventricles (L>R) as well as bilateral sacral cortical sulci.Images through posterior fossa are unremarkable.The signal void of major intracranial arterial branches are identified. There is anatomical variation of a partially empty sella.The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium however with evidence of a prior left-sided remote craniotomy.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells..
1.No acute intracranial process and negative diffusion weighted series.2.Extensive bilateral hemispheric white matter and to a lesser degree of bilateral basal ganglia highly suggestive of chronic nonhemorrhagic advanced small vessel ischemic strokes. Large focus of encephalomalacia involving left temporal and frontal lobe highly suggestive of a large chronic nonhemorrhagic ischemic stroke in the left MCA territory.3.Constellation of above changes results in ex vacuo dilatation of lateral ventricles and the cortical sulci.4.Evidence of prior remote left sided craniotomy.