left side weakness and numbness, seizure There is focal restricted diffusion on the right frontal periventricular white matter (series 405, image 192/34) indicating acute ischemic stroke. There is no evidence of susceptibility artifacts indicating hemorrhagic transformation.Diffuse patchy high signal intensities on bilateral periventricular white matters and centrum semiovale indicate extensive non specific small vessel ischemic disease. Focal encephalomalacia on the left side lower midbrain extends toward upper pons were seen. Multifocal various sized tissue losses on bilateral centrum semiovale indicating chronic ischemic infarction.Another encephalomalacia on the left mesial aspect of the cerebellum was also seen.There is evidence of linear encephalomalacia on the right lateral ventricle occipital horn with surrounding susceptibility artifacts indicating prior hemorrhagic lesion with associated ventricular dilatation.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Focal restricted diffusion on the right periventricular white matter indicating focal acute ischemic stroke without evidence of hemorrhagic transformation.2. Multifocal chronic ischemic infarctions with encephalomalacia involving bilateral centrum semiovale, bilateral periventricular white matter, left side pons, left midbrain and left cerebellum as described above.3. Focal encephalomalacia on the right occipital lobe with hemosiderin deposition indicating chronic hemorrhagic infraction.