Diagnosis: Syncope and collapse Dizziness and giddinessClinical question: 48 yo with vertigo, previous MI and stroke, concern for basilar strokeSigns and Symptoms: vertigo The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated on the current exam. No abnormal enhancing foci are identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a focus of volume loss and T2 and FLAIR signal hyperintensity present along the anterior aspect of the left inferior parietal lobule compatible with encephalomalacia. There are satellite punctate foci of T2 and FLAIR signal hyperintensity associated with this. On susceptibility imaging there are small foci of the signal loss within this area of encephalomalacia.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 basilar artery appears small and findings suggest bilateral fetal origins of the posterior cerebral arteries.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.A focus of encephalomalacia in the left inferior parietal lobule associated with small foci of chronic hemorrhage most likely is a due to a prior vascular event.2.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific, however given the above findings vascular event is favored. 3.There is no evidence for acute cerebral infarction.