96 year-old woman with history of CVA and new onset aphasia, right facial droop. Questionable left-sided weakness. There is no evidence of intracranial hemorrhage, mass or edema. No acute cortical stroke is seen. If acute infarction is suspected clinically, MRI can be obtained. A large area of encephalomalacia is seen in the distribution of the right posterior cerebral artery consistent with old stroke. There is ex vacuo dilatation of the posterior and temporal horns of the right lateral ventricle. Focal encephalomalacia is also seen in the bilateral cerebellar hemispheres consistent with old strokes. Extensive areas of periventricular white matter hypoattenuation are also noted consistent small vessel ischemic disease, of indeterminate age.
1. Multiple old strokes.2. Extensive small vessel ischemic disease, age indeterminate.