Clinical question: Cerebellar stroke, posterior circulation insufficiency. Signs and symptoms: Ataxia, falls. Nonenhanced brain MRI:Examination demonstrates a small focus of restricted diffusion/acute stroke (8 x 7 mm) in the immediate periventricular white matter of the left posterior frontal without evidence of hemorrhagic changes or mass effect.Additionally examination demonstrate extensive chronic nonhemorrhagic small vessel ischemic strokes involving the subcortical and periventricular white matter, bilateral thalami, bilateral basal ganglia and bilateral paramedian pons. There is no evidence of chronic cerebral cortical stroke however 2 adjacent tiny chronic right cerebellar ischemic strokes in the distribution of the right eye, is detected.Constellation of changes results in prominence of cortical sulci and mild prominence of the ventricles for patient's stated age and concerning for underlying volume loss. The signal void of all major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.
1.Acute nonhemorrhagic small vessel ischemic stroke (8 x 7 mm) in the left hemispheric periventricular white matter.2.Extensive chronic nonhemorrhagic small vessel ischemic strokes in the periventricular and subcortical white matter, bilateral thalami, bilateral basal ganglia and pons as detailed. Small chronic right PICA territory ischemic strokes as mentioned above.