Clinical question: Stroke. Signs and symptoms: Left-sided weakness. Nonenhanced brain MRI:Diffusion weighted images demonstrate no evidence of an acute ischemic stroke.FLAIR and T2-weighted images demonstrate a tiny focus of hemorrhagic encephalomalacia involving the cortex and subcortical white matter of left posterior frontal at the site of previously noted focus of low attenuation on prior recent head CT and likely representing a chronic small hemorrhagic stroke.Mild periventricular FLAIR hyperintensity and subtle foci of FLAIR and T2 hyperintensity in left thalamus, right basal ganglia, right anterior temporal cortex and more noticeably in the left paramedian pons without susceptibility signal changes and suggestive of mild chronic small vessel ischemic strokes.Supratentorial ventricular system are slightly prominent for age similar to prior head CT and with maintained midline.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.No acute intracranial process.2.Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed.3.Small focus of hemorrhagic encephalomalacia in the left posterior frontal suggestive of a small chronic ischemic stroke.4.Mild prominence of supratentorial ventricular system with maintained midline and stable since prior studies.