Diagnosis: WeaknessClinical question: r/o strokeSigns and Symptoms: ?new vs. chronic vs. none. L sided facial droop The CSF spaces are appropriate for the patient's stated age with no midline shift. A focus of encephalomalacia is present along the left superior frontal gyrus. There is associated focal enlargement of the left lateral ventricle.Multiple punctate foci of susceptibility effect are identified in the basal ganglia and brainstem. Additionally some punctate foci of susceptibility effect are present in the left medial temporal lobe.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions are present in the brainstem.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 demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is no evidence for acute cerebral infarction.2.A focus of encephalomalacia is present along the left superior frontal gyrus which can also be identified on the prior CT from 2012. Most likely this is vascular related.3.Microhemorrhages are present within the deep gray nuclei, medial temporal lobes and brainstem. This pattern of distribution is most consistent with hypertensive pattern of microhemorrhages.4.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 5.Punctate lesions in the brainstem are most likely vascular related.