Clinical question: Stroke. Signs and symptoms: Baseline dysarthria and slurred speech with acute worsening in ED. Nonenhanced brain MRI:Examination demonstrates a tiny 6 mm cortical focus of restricted diffusion in the left occipital lobe, additional linear focus of 18 x 6 mm in the periventricular white matter of the left hemisphere, a focus of approximately 11 mm in the subcortical white matter of right posterior frontal lobe and a punctate focus in the cortex of the left anterior parietal lobe. Findings demonstrate no evidence of hemorrhagic changes and without any mass effect.Additionally examination demonstrates a large focus of FLAIR hyperintensity involving the cortex and subcortical white matter of the left frontal lobe and including the left basal ganglia consistent with a large chronic left MCA territory cortical stroke. Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes are also noted. Small focus of left occipital chronic cortical stroke and multiple tiny foci in bilateral cerebellar hemispheres consistent with chronic small ischemic strokes.There is significant ex vacuo dilatation of left hemispheric cortical sulci secondary to large chronic stroke and mild bilateral (left greater than right) expected dilatation of lateral ventricles however with maintained midline.Findings and concerns on this exam were discussed by phone with the referring physician Sridharan, Aadhavi # 1071 at the time of review of exam.
1.Multiple foci of acute ischemic strokes in the left occipital, left hemispheric periventricular white matter, left anterior parietal cortex and subcortical white matter of right posterior frontal lobe. Findings are nonhemorrhagic and produces no mass effect.2.Large chronic left MCA ischemic stroke, moderate chronic small vessel ischemic strokes, small chronic right frontal cortical stroke, a small left occipital chronic stroke and tiny bilateral cerebellar chronic strokes are also noted.