Diagnosis: Slurred speechClinical question: strokeSigns and Symptoms: stroke MRI of the brainThere is a focus of diffusion restriction present in the right centrum semiovale. It measures approximately 10 x 8 mm axial dimensions.A punctate focus of susceptibility effect is present in the right thalamus. Another punctate focus is present along the right posterior temporal lobe. Another one is present along the left caudate nucleus. Another focus of punctate signal loss is present in the left cerebellar hemisphere.Small cystic fluid collections are present between the right superior frontal gyrus and falx as well as adjacent to the left parietal lobe. These most likely represent small arachnoid cysts.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 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.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The ACOMA is fenestrated. The vertebral arteries are similar in size. There is fetal origin of the posterior cerebral arteries bilaterally. The p1 segments are medium sized.The left vertebral artery is larger than the right vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery is larger than the right vertebral artery. The LCCA originates from the innominate artery.
1.There is a lacunar infarct in the right centrum semiovale.2.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 3.There are multiple microhemorrhages present . These are mainly but not exclusively in a distribution suggestive of hypertension.4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.5.A couple small arachnoid cysts are present.