Clinical question: 61yo with h/o aortic occlusion resulting in spinal cord infarct and gangrene of toes from thrombosis. Having persistent Left facial numbness (temporal sparing) and L hand/wrist. R/o acute ischemia or central lesion or peripheral pathologySigns and Symptoms: L facial numbness, L hand numbness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal 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 left vertebral artery is larger than the right vertebral artery.On susceptibility imaging, some asymmetry in the posterior fossa venous drainage pattern is present which is unchanged since the prior exam. This may be developmental in origin.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.No evidence for acute ischemic cerebral infarction.