Reason: brainstem ischemia History: dysparthria The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are punctate T2 and flair hyperintense lesions present in the brainstem especially the left pons.On susceptibility imaging there is a hypointense focus present in the pons just to the right of midline. On T2 imaging and appears to have a central signal hyperintense focus.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrates a small maxillary sinuses and some scattered mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.A 5mm hemorrhagic focus is present in the pons. It is possible this may represent a small cavernoma but could represent a small hemorrhage in the early chronic/late subacute stage. Examination when the patient is able to cooperate better with MRI may be useful in evaluating this further.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.No evidence for acute ischemic stroke or intracranial mass.4.Examination is somewhat compromised due to patient motion which may obscure more subtle abnormalities. 