Diagnosis: Aphasia following cerebral infarctionClinical question: cause for confusion and aphasiaSigns and Symptoms: aphasia, poor memory The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Incidental note is made of partial empty sella.There is signal change involving the left middle temporal gyrus with high signal on T2 and FLAIR in the area measuring 10 x 25 mm axial dimensions and involving both gray and white matter. There is some associated volume loss. This suggests this represents encephalomalaciaAnother similar focus is present in the right precentral gyrus and is associated with punctate foci of susceptibility effect.There are punctate foci of signal hypointensity in the subcortical white matter bilaterally of a mild to moderate degree on SWI.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal 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.The visualized portions of the paranasal sinuses demonstrate near complete opacification of the right maxillary sinus and mucous retention cysts in the left maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Small focus of encephalomalacia is present in the left temporal lobe centered in the left middle temporal and inferior temporal gyri.2.Another small focus of encephalomalacia is present in the right precentral gyrus3.Subcortical microhemorrhages are suspicious for amyloid angiopathy.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 