Clinical question: Evaluate for ischemia. Signs and symptoms: Right face/arm/leg numbness/pain. Nonenhanced brain MRI:No evidence of acute ischemic stroke is present.Examination demonstrates diffuse patchy foci of flair hyperintensity involving the subcortical and periventricular white matter, minimally off bilateral basal ganglial, right thalamus and extensively of the pons which considering patient's stated age of 74 findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes. There is no detectable signal abnormality cerebral cortex or the cerebellum -- vermis. The signal void of major intracranial arterial branches are identified.The intracranial venous sinuses demonstrate normal signal intensity.Images through the orbits are unremarkable however in the distal prior cataract surgery is noted.All paranasal sinuses demonstrate normal pneumatization signal pattern.
1.No acute ischemic stroke.2.Chronic nonhemorrhagic small vessel ischemic strokes as detailed above.