Clinical question: CVA. Signs and symptoms: Facial droop. Nonenhanced brain MRI:Small focus of subcortical restricted diffusion measuring approximately 6 mm in size is noted in the right precentral gyrus.Examination in addition demonstrate extensive periventricular, subcortical, basal ganglia, thymic and pontine confluent foci of flair hyperintensity with resultant mild ex vacuo dilatation of the supratentorial ventricular system consistent with advanced chronic small vessel ischemic strokes.The signal void of major intracranial arterial branches are identified. There is small caliber of right carotid artery across the skull base compared to the left. Further assessment with vascular imaging is recommended.Unremarkable calvarium and orbits. Sinusitis is noted.
1.Small focus of acute ischemic change in the right anterior parietal white matter.2.Extensive chronic small vessel ischemic strokes in the subcortical, periventricular, basal ganglia, thalami and pons as detailed.3.Small caliber of right internal carotid artery across the skull base compared to left. Evaluation with dedicated vascular imaging is recommended.