Clinical question: Prior to TPA and cardiac history, assess for CVD. Signs and symptoms: Concentration problems. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no evidence of acute ischemic stroke is detected.Examination demonstrate periventricular patchy flair hyperintensity in the periventricular and to a lesser degree subcortical white matter of cerebral hemispheres as well as minimally in bilateral basal ganglia which considering patient's stated age of 77 likely representing chronic nonhemorrhagic small vessel ischemic strokes of mild degree. Slight prominence of cortical sulci and ventricular system may be within upper normal range for his stated age. Tiny foci of throughout hyperintensity in bilateral cerebellar hemispheres are suggestive of very small chronic strokes.The signal void of major intracranial vasculature is identified.Calvarium, skull, visualized paranasal sinuses and orbits are unremarkable.
1.No acute intracranial process.2.Findings of mild chronic small vessel ischemic strokes and tiny chronic bilateral cerebellar ischemic strokes as detailed.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoids.