Diagnosis: WeaknessClinical question: assess for expanding old infarction or new infarctionSigns and Symptoms: gait instability The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 and FLAIR hyperintense lesion present along the right posterior lateral aspect of the medulla measuring approximately 5 x 4 mm in axial dimensions which demonstrated diffusion restriction in the October exam. The diffusion restriction has resolvedNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. In general there appears to be bilateral fetal origins of the posterior cerebral arteries with a small basilar artery.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus associated with a asymmetrically smaller right maxillary sinus compared to the left maxillary sinus and thick walls of the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Findings are compatible with an old lacunar infarct in the right medulla. This was in the acute phase in October.2.Findings are compatible with silent sinus syndrome involving the right maxillary sinus