59-year-old female presents with left-sided facial /hand numbness There is a focus of restricted diffusion in the right thalamus with associated T2 hyperintensity, no hemorrhage, and no associated mass effect. No intracranial mass or mass-effect elsewhere in the brain. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. More prominent T2/FLAIR hyperintensity in the pons may also reflect small vessel ischemic disease, however, prior osmotic demyelination remains a consideration. Small focus of signal abnormality and volume loss in the right occipital cortex may be related to prior infarct or other injury. There are also scattered punctate foci of susceptibility in the deep white matter of the bilateral cerebral hemispheres, nonspecific, but consistent with chronic microhemorrhages. Major flow-voids are preserved. Sella is grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Note is made of pthisis bulbi involving the right globe.
1. Acute right thalamic infarct.2. Chronic small vessel ischemic disease. Pontine signal abnormality may also be related to chronic small vessel ischemic disease although remote osmotic demyelination is an additional consideration. Scattered chronic microhemorrhages in a nonspecific distribution also noted. There is also a small focus of signal abnormality in the right occipital cortex which may be related to prior ischemia or other injury.3. Pthisis bulbi involving the right globe.