Slurred speech and left arm weakness. Rule out acute stroke. The examination is limited by patient motion, which is most pronounced on the post contrast images.There is no acute infarct or intracranial hemorrhage, accounting for cortical mineral deposition in the chronic infarcts. The encephalomalacia and gliosis from the chronic right posterior cerebral artery infarct, involving the right occipital, temporal and parietal lobes, has not changed. The smaller infarct involving the inferior right cerebellum is also unchanged. Patchy and confluent cerebral white-matter T2 hyperintense lesions also remain unchanged. Also, the focal T1-hypointense, T2-hyperintense signal in the upper right pons is unchanged. The ventricles as well as the other CSF-containing spaces remain enlarged moderately, reflecting underlying brain volume loss which is most prominent in the anterior and medial temporal lobes. There is no mass-effect, midline shift or brain herniation. The major intracranial vascular flow voids are preserved, accounting for diminutive right posterior cerebral artery, which probably reflects the chronic nature of its territorial infarct. Accounting for limitation caused by motion, there is no abnormal gross intracranial contrast enhancement.There is mild mucosal thickening in the ethmoid sinuses. The mastoid air cells are clear. There is no gross orbital abnormality. There is no destructive lesion of the mildly thickened skull.
1.Examination is limited by patient motion, especially on postcontrast imaging.2.No acute infarct or intracranial hemorrhage. No definite brain metastasis.3.Unchanged chronic right posterior cerebral artery and small right cerebellar and right pontine infarcts as well as moderate diffuse cerebral white-matter changes of chronic microvascular ischemia. 4.Brain volume loss remains most prominent in the anterior and medial temporal lobes.