Clinical question: Stroke workup. Signs and symptoms: Right hand weakness and slurred speech. Nonenhanced brain MRI:Diffusion weighted images are negative for an acute ischemic stroke.Extensive periventricular and subcortical FLAIR hyperintensity in bilateral cerebral hemispheres as well as bilateral basal ganglia and to a lesser degree bilateral thalami and pons are again identified. There is subtle interval progression of findings in the pons since prior exam. Finding consistent with chronic small vessel ischemic strokes.Multiple small foci of susceptibility in the cerebral hemisphere are consistent with chronic microhemorrhages.No detectable cortical signal abnormality and unremarkable bilateral cerebellar hemispheres and vermis.Signal void of major intracranial arterial branches are identified.Unremarkable images through the orbits, calvarium and paranasal sinuses.
1.No acute intracranial process.2.Extensive chronic findings of small vessel ischemic strokes as detailed. There is mild progression of disease in the pons since prior exam.