Female, 77 years old, with left-sided weakness. Evaluate for stroke. A 6-mm focus of restricted diffusion is seen just inferior to the hand motor area of the right precentral gyrus. A 4-mm focus of restricted diffusion is also evident within the left cerebellum. There may be a punctate focus of restricted diffusion within the far posterior right cerebellum but this is equivocal.On perfusion imaging, MTT and TTP maps demonstrate abnormal elevated values corresponding to the right MCA distribution. rCBV and rCBF maps, however, show no large deficits, and if anything, the relative blood volume and blood flow within the right MCA distribution seems to be slightly increased compared to the left.Numerous scattered foci of T2 hyperintensity are seen including within the periventricular and subcortical white matter of the cerebral hemispheres and brainstem. No evidence of significant parenchymal edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is evident.There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collection. A focus of susceptibility along the left lateral ventricular atrium is likely related to chronic microhemorrhage. The ventricular system is normal in size and morphology.
1.Small foci of restricted diffusion are seen involving the tissues just inferior to the hand motor area of the right precentral gyrus as well as the left cerebellar hemisphere, and questionably in the right cerebral hemisphere.2.Perfusion imaging demonstrates abnormally elevated MTT and TTP in the distribution of the right MCA indicating either delayed bolus delivery and/or prolonged bolus flow-through. These findings could reflect an upstream stenosis with collateralization. However, the rCBV and rCBF maps show no significant deficits, and if anything, flow and volume are very slightly elevated in the right MCA distribution which would suggest largely intact cerebrovascular compensatory mechanisms.3.The background brain demonstrates evidence of chronic prior microvascular ischemic disease. No other acute intracranial abnormalities are seen.