Brain stem acute ischemic stroke: left hemiparesis. There are multiple scattered foci of restricted diffusion and high T2 signal in the bilateral posterior cerebral hemispheres, including the right thalamus, left hippocampal tail, bilateral parietal and occipital lobe cortices, and splenium of the corpus callosum, as well as in the right pons and middle cerebellar peduncle, and left cerebellar hemisphere. There is a background of diffuse patchy cerebral and pontine white matter T2 hyperintensity without associated restricted diffusion, which may represent chronic small vessel ischemic disease. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions in a left ethmoid sinus and a small retention cyst in the right maxillary sinus.
Multiple supratentorial and infratentorial small acute embolic infarcts in the posterior circulation distribution, but no evidence of acute hemorrhage or midline shift. Please refer to the recent head CTA regarding the status of the vasculature. 