Clinical question: History of CVA. Signs and symptoms: AMS. Nonenhanced brain MRI:Examination demonstrates an acute ischemic stroke in the distribution of left MCA in the operculum on the left frontal lobe. The finding measures at least 29 x 39 transaxial dimensions and 29-mm craniocephalad axis. There is evidence of mild hemorrhagic changes within the stroke. There is very subtle regional mass effect and effacement of adjacent cortical sulci without deviation of midline.Examination in addition demonstrate extensive periventricular and subcortical patchy foci of flair hyperintensity consistent with moderate chronic nonhemorrhagic small vessel ischemic stroke. Similar signal changes are also present in bilateral basal ganglia, thalami and pons.There are tiny foci of flair hyperintensity in bilateral cerebellar hemispheres inferiorly representing small bilateral chronic cerebellar pica territory ischemic strokes. There is no evidence of chronic cortical stroke of the cerebral hemispheres.Slight prominence of cortical sulci and ventricular system is within expected range for the stated age of 80.The signal void of major intracranial arterial branches are identified.
1.Acute minimally hemorrhagic ischemic stroke in the operculum of left frontal lobe measuring at least 29 x 39 x 29-mm size. Subtle regional mass effect and no deviation of midline.2.Extensive chronic nonhemorrhagic small muscle ischemic strokes.3.Multiple tiny bilateral pica territory chronic cerebellar strokes.