Clinical question: Recent cerebellar stroke? Signs and symptoms: Headache and gait instability. Pre-and post-enhanced brain MRI:Diffusion-weighted images demonstrate a small focus of restricted diffusion measuring at 5 x7 mm in transaxial dimension involving the lingula of vermis without evidence of hemorrhage. This finding demonstrate enhancement and likely representing subacute state of the stroke. This finding is also well identified on T2 and flair images.Diffuse periventricular and to a lesser degree subcortical small foci of flair hyperintensity consistent with chronic small vessel ischemic strokes demonstrate no convincing evidence of interval change. Similar signal changes are also present in bilateral basal ganglia (left greater than right) as well as bilateral thalami and extensively in the pons all consistent with advanced chronic lacunar infarcts without evidence of hemorrhagic signal changes or significant interval change in the extent.Multiple foci of flair hyperintensity in bilateral cerebellar hemispheres consistent with prior chronic cerebellar strokes demonstrate no significant change since prior exam. Note should be made that precise comparison for interval change is difficult due to extent of disease.Post-enhanced images demonstrate above-mentioned enhancement of min ischemic stroke and negative otherwise.The signal void of major intracranial arterial branches are identified.The signal intensity or intracranial venous sinuses are within normal and mid normal pattern of enhancement.
1.Enhancing subacute ischemic stroke of the lingula of vermis as detailed above.2.Extensive chronic nonhemorrhagic small vessel ischemic strokes in periventricular and subcortical white matter, extensive chronic nonhemorrhagic lacunar infarcts of bilateral basal ganglia, thalami and extensively of the pons without convincing evidence of interval change. Multiple bilateral cerebellar chronic ischemic strokes without significant change.3.Unremarkable post-enhanced images other than the above detailed enhancing vermian stroke.