Clinical question: Patient with multiple cerebral infarcts and cerebellar hypoattenuation. Signs and symptoms: AMS. Nonenhanced brain MRI:Acute bilateral cerebellar strokes are again demonstrated with increased internal hemorrhage since prior exam. The size of strokes on FLAIR and T2-weighted images demonstrate no significant change. The fourth ventricle demonstrates subtle decreased size secondary to mass effect and in midline similar to prior exam. Numerous tiny scattered foci of restricted diffusion in the periventricular, subcortical, bilateral basal ganglia (L>R) demonstrate no significant change since prior exam. These findings are not associated with any susceptibility signal changes to suggest hemorrhage. Mildly prominent supratentorial ventricular system remain stable since prior exam and with maintained midline.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium and orbits.
1.Large bilateral cerebellar acute strokes demonstrate no change in size or subtle mass effect however there is interval increased internal petechial hemorrhage since prior exam.2.Stable scattered multifocal periventricular, subcortical and bilateral basal ganglia acute ischemic stroke demonstrate no significant change and no evidence of hemorrhagic conversion.3.Stable mildly dilated supratentorial ventricular system and with maintained midline.