56 years Male (DOB:5/26/1959)Reason: stroke work up History: right sided weaknessPROVIDER/ATTENDING NAME: HELENE G RUBEIZ HELENE G RUBEIZ There is a 5 mm focus of diffusion restriction present along the medial aspect of the left temporal lobe. This is associated with T2 signal hyperintensity and FLAIR signal hyperintensity. Additionally there are punctate foci of diffusion restriction present in the left middle frontal gyrus, the left centrum semiovale and the left postcentral gyrus as well as gray matter adjacent to the posterior aspect of the deep portion of the left superior frontal sulcusThere is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These predominate over the left hemisphere when compared to the right.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There are multiple punctate foci of microinfarct and scattered in the left middle cerebral artery territory.2.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. These clearly predominate over the left hemisphere. Given the above findings of left middle cerebral artery territory microinfarcts and these findings, the possibility that there is underlying carotid stenosis on the left side is raised. Study of the carotid vasculature may be of further benefit if clinically appropriate.