Clinical question: Acute ischemic stroke. Signs and symptoms: Right leg weakness. Nonenhanced brain MRI:Examination demonstrates a 10 x 10 mm focus of restricted diffusion in the left cerebellum consistent with an acute nonhemorrhagic stroke. A tiny linear restricted diffusion is also noted in the right posterior cerebellum as well highly suggestive of a small acute stroke.Additionally there is a large left mid to posterior temporal and occipital as well as left pontine and multiple tiny right occipital foci of restricted diffusion as well consistent with acute ischemic stroke in the distribution of the left PCA.There is no evidence of hemorrhagic changes with the findings.Additionally examination demonstrated a large chronic left posterior frontal and parietal ischemic stroke without evidence of hemorrhagic changes. There is ex vacuo dilatation of left lateral ventricle secondary to chronic strokes and mild effacement of adjacent cortical sulci to the left temporal-occipital acute stroke.Examination also demonstrates moderate degree of chronic small vessel ischemic strokes.Prominence of cortical sulci and dilatation of supratentorial ventricular system consistent with underlying parenchymal volume loss.The signal voids of major intracranial arterial branches are identified.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.Large acute nonhemorrhagic ischemic stroke in left temporal / occipital and left thalamus. Small foci of acute ischemic stroke in bilateral cerebellum (L>R) is also noted as detailed above.2.Chronic nonhemorrhagic small vessel ischemic strokes and a large chronic left MCA territory posterior frontal/parietal cortical stroke as mentioned.3.Prominence of cortical sulci and supratentorial ventricular system consistent with underlying parenchymal volume loss.