Stroke: Nystagmus, N/V, hypertension. There is a punctate focus of restricted diffusion in the right middle frontal gyrus subcortical white matter, without associated susceptibility effect. There is otherwise moderate scattered cerebral white matter T2 hyperintensity bilaterally. There is a prominent perivascular space in the left pons. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is paucity of the right internal carotid artery flow void. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Punctate acute infarct in the right middle frontal gyrus subcortical white matter without evidence of hemorrhagic transformation. A background of moderate cerebral white matter signal abnormality likely represents chronic small vessel ischemic disease. Significant steno-occlusive disease involving the right internal carotid artery is better depicted on the recent CTA.