Wk 3, Case 2 - Review

Patient History

A 76-year-old man with a history of hypertension, hyperlipidemia, and congenital bronchial atresia presents to the emergency department with a chief complaint of acute-onset slurred speech.

Findings

MRI Brain:

Restricted diffusion in the right superior cerebellum in the SCA territory with associated increased T2 and FLAIR signal.

ASL perfusion sequence does not include the area of diffusion abnormality within the field-of-view.

Small bilateral subdural effusions measuring4 mm on the left, and 2 mm on the right.

Ventricles and sulci are slightly prominent but normal in size and configuration for age.

Scattered areas of increased T2 and FLAIR signal in the brainstem, white matter of both cerebral hemispheres, and basal ganglia, consistent with mild chronic small vessel ischemic changes.

No other abnormal areas of signal in the brain.

Normal flow voids in the major arteries and dural sinuses.

Polypoid mucosal thickening in the maxillary sinuses on both sides. Otherwise unremarkable signal paranasal sinuses. Small bilateral mastoid effusions, larger on the right.

Bilateral cataract surgery.

Conclusion

1. Subacute right superior cerebellar cortical infarct.

2. Small bilateral chronic-appearing subdural effusions/hematomas without mass effect.