Clinical question: Evaluate for stroke. Signs and symptoms: LUE pain/numbness, slurring of speech. Nonenhanced brain MRI:Examination demonstrates small foci of restricted diffusion involving the cortex of the right post central gyrus and adjacent subcortical white matter consistent with acute to late acute nonhemorrhagic ischemic stroke. This finding was noted on the prior head CTs. There is no associated mass effect with this finding.Additionally examination demonstrate several tiny foci of flair hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres. Tiny similar finding in the right external capsule is also noted. Findings highly suggestive of chronic small vessel ischemic stroke of mild degree.The signal intensity of brain parenchyma remains within normal otherwise. There is a slight prominence of cortical sulci for patient's stated age in a generalized pattern. Ventricular system are within normal size and morphology and maintained midline.There is revisualization of a small arachnoid cyst in the anterior aspect of right middle cranial fossa with subtle mass effect on the right temporal tip similar to prior head CT.Signal void of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Calvarium, orbits, paranasal sinuses and mastoid air cells are unremarkable there
1.Tiny foci of cortical and subcortical restricted diffusion involving right post central gyrus as was seen on prior head CTs.2.Findings of mild chronic small vessel ischemic strokes as detailed.3.Mild generalized prominence of cerebral cortical sulci for age and unremarkable exam otherwise.