Clinical question: Stroke. Signs and symptoms: Aphasia expressive. Nonenhanced brain MRI:No detectable acute intracranial process and in particular no evidence of acute ischemic stroke.Examination demonstrate diffuse nonspecific foci of flair hyperintensity only in the periventricular and subcortical white matter of cerebral hemispheres which considering patient's stated age of 84 most likely representing chronic nonhemorrhagic small vessel ischemic strokes of mild-to-moderate degree.There is also a small focus of cortical and subcortical encephalomalacia in the left frontal lobe consistent with a chronic nonhemorrhagic ischemic stroke. Images through posterior fossa demonstrate multiple tiny chronic cerebellar ischemic strokes in the distribution of Michael branches. Unremarkable signal intensity of brain parenchyma otherwise.The signal void of major intracranial arterial branches are identified.Incidental note is made of anatomical variation of partially empty sella.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells and calvarium.
1.No acute intracranial process.2.Mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical and periventricular white matter. Multiple small pica territory bilateral cerebellar chronic strokes.3.Unremarkable exam otherwise.