90 years Female (DOB:4/6/1926)Reason: assess for new stroke History: right-sided weakness and slurred speechPROVIDER/ATTENDING NAME: THOMAS L FISHER JACQUELINE T. BERNARD There is a punctate focus of diffusion restriction present in the right paramedian pons. This is newThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are several lesions of T2 and FLAIR signal hyperintensity in the brainstem and cerebellum.On susceptibility imaging there is a focus of susceptibility effect associated with low signal on T2 imaging in the left postcentral gyrus which on T2 measures approximately 19 x 7 mm axial dimensions. This was present on the prior exam and is unchanged Additionally there are multiple punctate foci of susceptibility effect in the subcortical white matter of both hemispheres. Additionally there is a punctate focus of susceptibility effect in the left medial thalamus and the left upper thalamus. These were also present on the prior exam and have not changed significantly.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the maxillary sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is a punctate acute microinfarct infarct in the right paramedian pons. This is new since the prior exam.2.There is redemonstration of a hemorrhagic focus in the left postcentral gyrus probably from an old hemorrhage.3.Multiple microhemorrhages in the brain parenchyma involving predominantly subcortical white matter are present. Most likely these are related to amyloid angiopathy based on the pattern but this is somewhat nonspecific.4.Periventricular and subcortical white matter lesions as well as a couple lesions in the brainstem and cerebellum of a mild degree are nonspecific. At this age they are most likely vascular related. They are essentially stable and compared to prior exam