Diagnosis: Other symptoms and signs involving the musculoskeletal systemClinical question: please eval for CVASigns and Symptoms: left sided weakness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Small patchy foci of signal hyperintensity on T2 and FLAIR MR imaging are present in the right cerebellar hemisphere. Punctate foci of T2 and FLAIR signal hyperintensity are present in the cerebellar hemispheres bilaterally. There is no associated mass effect or diffusion restriction associated with these. There is a focus of susceptibility effect present along the inferior aspect of the left cerebellar hemisphere along the cortex of the left inferior semilunar lobule.A T2 and FLAIR signal hyperintense lesion is present in the medial aspect of the left thalamusSeveral punctate foci of signal loss on susceptibility imaging are present in the right medial temporal lobe subcortical white matter, the right frontal lobe, the left thalamus and the right basal gangliaNo 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Lesions present in the cerebellum are present more on the right cerebellar hemisphere than the left which are suspected most likely to be vascular in etiology.2.Findings are compatible with an old hemorrhagic focus in the left cerebellar hemisphere inferiorly3.Findings are compatible with old lacunar infarction in the left thalamus4..Microhemorrhages present in the left thalamus, right basal ganglia and some of the subcortical white matter are nonspecific5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 6.There is no evidence for acute ischemic cerebral infarction present.7.Examination is mildly compromised due to patient motion which may obscure more subtle abnormalities.