86 years, Male, slurred speech, ischemic stroke Multiple sequences are motion degraded. There are multiple foci of restricted diffusion in the right frontal lobe including the right precentral gyrus as well as the right middle frontal gyrus consistent with acute infarct. There is corresponding T2/FLAIR hyperintensity. Additional extensive confluent T2/FLAIR hyperintensity seen in the bilateral periventricular and subcortical white matter as well as in the pons which is most compatible with advanced chronic small vessel ischemic disease. Foci of susceptibility effect are seen involving the right posterior frontal lobe in the area of the acute infarct suggesting petechial hemorrhages. No associated mass effect. Additional foci of susceptibility in the left cerebellar hemisphere, left thalamus, and brainstem are compatible with chronic microhemorrhages, with a distribution favoring a chronic hypertensive etiology.There is prominence of the ventricular system which is likely reflective of global parenchymal volume loss. No intracranial mass or mass effect. No extra-axial collections. Major flow-voids are preserved. Small bilateral maxillary mucus retention cysts.
1. Acute infarct in the right posterior frontal lobe including the right precentral and middle frontal gyri.2. Petechial hemorrhagic foci are noted in the region of the right posterior frontal infarct without mass effect.3. Additional foci of chronic microhemorrhages favoring a chronic hypertensive etiology.4. Advanced chronic small vessel ischemic changes.