Diagnosis: Other specified disorders of muscleClinical question: please r/o stroke vs MS lesionsSigns and Symptoms: left sided sensory changes and weakness MRI of the brainThere is a 12 x 18 mm axial dimension focus of diffusion restriction present along the right thalamus and posterior limb of internal capsule.There is a moderate degree of periventricular and subcortical patchy hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very small. The vertebral arteries are similar in size.
1.There is an acute ischemic cerebral infarction involving the right thalamus.2.There is no evidence for cerebrovascular occlusive disease present.3.There is a moderate degree of periventricular and subcortical white matter patchy lesions present. This is quite unusual at this age. One may consider CADASIL in the differential diagnosis in the appropriate clinical setting. Differential considerations include demyelination, vasculitis. It is nonspecific.