Clinical question: Rule out ischemic lesion. Signs and symptoms: Left hemiparesis. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no evidence of acute ischemic stroke.Ectopia of cerebellar tonsils of approximately 5 mm with subtle deformity of cerebellar tonsils.There are several punctate foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter and with normal morphology and signal intensity of brain parenchyma otherwise on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.The signal void of major intracranial arterial branches are identified.Signal intensity of intracranial venous sinuses appear normal.Images through the orbits, paranasal sinuses and mastoid air cells are unremarkable.
1.No evidence of acute intracranial process.2.Mild ectopia of cerebellar tonsils of approximately 5 mm with subtle deformity of cerebellar tonsils.3.Few scattered mostly bilateral frontal subcortical and periventricular foci of FLAIR hyperintensity are nonspecific however in proper clinical setting could represent chronic changes of mild small vessel ischemic strokes.4.Unremarkable nonenhanced brain MRI otherwise.