Other speech disturbance Clinical question: acute ischemic strokeSigns and Symptoms: left sided weakness and slurred speech MRI of the brainThere are small (36x10 mm axial dimension) patchy foci of diffusion restriction along the lateral aspect of the right precentral gyrus extending to the centrum semiovale adjacent to the right middle frontal gyrus. There is associated FLAIR and T2 signal hyperintensity. There is a punctate DWI signal hyperintense focus along the right occipital lobe which is too small to characterize on ADC maps.A focus of encephalomalacia is present in the right middle frontal gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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 demonstrate mild mucosal thickening and a right maxillary sinus mucous retention cyst. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact and are small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is 67%stenosis along the origin of the right vertebral artery. There is 50%stenosis along the origin of the left vertebral artery.
1.Small acute cerebral infarction along the lateral aspect of the right precentral gyrus and adjacent white matter as described above.2.Encephalomalacia along the left middle frontal gyrus.3.67% stenosis at the origin of the RVA.4.50% stenosis at the origin of the LVA.5.No evidence for intracranial cerebrovascular occlusive disease.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 