Diagnosis: Other specified disorders of muscleClinical question: history of old stroke, possible new strokeSigns and Symptoms: as above MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of signal hyperintensity on T2 and FLAIR MRI are present in the left thalamus and ponsThere are small foci of susceptibility effect in signal loss present in the basal ganglia thalami and pons. The largest one is located in the right thalamus and can be identified on T2-weighted imaging root measures approximately 5 x 7 mm axial dimensions.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 demonstrate mucosal thickening. 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 small.. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.There are multiple microhemorrhages present in the basal ganglia, thalami and brainstem was pattern is suggestive of hypertensive microhemorrhages. 2.There is a 1cm old hemorrhagic focus in the right thalamus. 3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for intracranial cerebrovascular occlusive disease.5.No evidence for intracranial aneurysm.