Altered mental status and acute onset of slurred speech, right facial droop, confusion and bilateral lower extremity weakness. Rule out stroke. The study is moderately limited by patient motion.Brain MRI:There is an area of diffusion restriction involving the right cerebellar hemisphere. In addition, there are numerous foci of diffusion restriction involving both cerebellar hemispheres and, to a lesser extent, both cerebral hemispheres. While many of the lesions are located within the white matter, some of them involve the overlying cortex. There is a tiny focus of susceptibility effect in the left occipital lobe which probably reflects the presence of blood products. Otherwise, there is no gross intracranial hemorrhage within the limitation of this motion-degraded examination. There is confluent periventricular cerebral white matter T2 hyperintensity without diffusion restriction, probably reflecting chronic microvascular ischemia. Given the small size of the diffusion restricted lesions, they are not associated with significant mass effect. There is no midline shift or herniation. The ventricles and other CSF-containing spaces are normal in size. The orbits are unremarkable. There is fluid in the mastoid air cells and there is mild anterior ethmoid mucosal thickening. The other included paranasal sinuses are clear. Head MRA:There is no large vessel significant stenosis or occlusion. There might be mild narrowing of the left internal carotid artery as it enters and within the cavernous sinus but this study lacks the quality needed for assessing for mild stenosis. There is no severe narrowing in the internal carotid arteries or the paired middle and anterior cerebral arteries. Of note, the left A1 segment is very small which is probably congenital given the large right A1 segment and anterior communicating artery. The flow in the more downstream anterior cerebral arteries is fairly symmetric. Similarly, the flow in the posterior cerebral arteries is preserved and symmetric. The basilar artery is also without significant narrowing. Visualization of most of the intracranial vertebral arteries is severely affected by motion.
1.The examination is moderately limited by patient motion.2.Right cerebellar and numerous other smaller foci of diffusion restriction throughout the brain are compatible with acute/subacute infarcts. Tiny focus of susceptibility effect in the left occipital lobe is probably related to microscopic blood products, likely chronic. Otherwise, there is no gross intracranial hemorrhage, within the limitation of the examination.3.Mild background chronic microvascular ischemia of the white matter.4.Within the limitation of the examination, there is no significant intracranial vessel narrowing or occlusion. Dr. Monther Qandeel discussed the above results with Dr. Matthew Burns over the phone on September 19, 2015 at 1730 hours.