Patient presenting with left facial droop, dysarthria, left-sided weakness and altered mental status, evaluate for stroke. There is a slightly linear, apparent area of diffusion restriction in the left side of pons, as seen on image 11 of series 6, with corresponding low signal and ADC sequence with a possibility of an acute infarct. There is no associated T2 signal abnormality however. There are multiple areas of increased FLAIR signal and volume loss consistent with encephalomalacia throughout the cerebral hemispheres, particularly bilateral frontal lobes, bilateral parietal lobes, and left occipital lobe, as well as the bilateral cerebellar hemispheres which are consistent with chronic infarcts. Additional FLAIR signal abnormalities in the periventricular white matter and brainstem are nonspecific but are suggestive of a component of mild chronic microvascular ischemic disease. There is no evidence of mass. The ventricles and and sulci are prominent, consistent with parenchymal volume loss, advanced for patient's age. There is a small focus of susceptibility signal changes in left peri-Rolandic area, which may represent a chronic microhemorrhage or mineralization. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. Bilateral maxillary sinus mucus retention cysts and mild right mastoid opacification are noted.
1.Apparent focus of restricted diffusion and ADC hypointensity without clear corresponding T2 signal abnormality in the left aspect of the pons, which may represent a hyperacute infarct, although artifact is a possibility.2.Multiple chronic infarcts throughout the bilateral cerebral and cerebellar hemispheres as described above.