Clinical question: Patient with right vertebral dissection. Signs and symptoms: Diplopia and vomiting. Nonenhanced brain MRI:Examination demonstrates diffuse scattered foci of restricted diffusion in the right cerebellum both inferiorly and superiorly as well as a punctate focus within the right cerebellar tonsil consistent with acute ischemic strokes. Findings are also well visualized on Flair and T2-weighted images. There is no evidence of hemorrhage or mass effect. Fourth ventricle remains within normal size and midline and CSF spaces/cisterns in the posterior fossa remain patent.There is no detectable acute ischemic stroke in the supratentorial brain parenchyma.FLAIR and T2-weighted images demonstrate above detailed acute nonhemorrhagic strokes. Additionally there is a single tiny focus of FLAIR hyperintensity in the subcortical white matter of right parietal lobe which is believed to represent an artifactual finding. The signal void of the right vertebral artery is identified intracranially.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Findings and concerns on this exam were discussed by phone with referring services Fadi Mikhail #6229 at the time of review of the study.
1.Diffuse patchy foci of acute nonhemorrhagic ischemic stroke in the right cerebellum and right cerebellar tonsil without significant mass effect.2.Unremarkable nonenhanced brain MRI otherwise.