Clinical question: Dizziness, bidirectional nystagmus, rule out stroke. Signs and symptoms: As above. Nonenhanced brain MRI:No evidence of acute intracranial process and no acute ischemic stroke.Examination demonstrate two small foci of T2 hyperintensity in the inferior aspect of bilateral cerebellar hemispheres highly suspected of tiny chronic ischemic strokes.Additionally images through supratentorial space demonstrate minimal primarily periventricular and subcortical foci of flair hyperintensity which considering patient's stated age of 81 likely representing chronic small vessel ischemic strokes of mild degree.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise for age.The signal void of major intracranial arterial branches are identified. The signal intensity of intracranial venous sinuses are unremarkable.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. A tiny retention cyst in the dependent left maxillary sinus is however present.
1.No acute intracranial process.2.Finding suggestive of mild small vessel ischemic strokes supratentorially and two tiny bilateral cerebellar chronic ischemic strokes are noted.3.Unremarkable nonenhanced brain MRI otherwise for the stated age of 81.