Is this embolic or thrombotic stroke?
Technique: Multiplanar, multisequence non contrasted MRI images of the brain were obtained.
FINDINGS: Since the most recent examination there is now multipl supra and infratentorial punctate areas of diffusion restriction consistent with lacunar infarcts.
The cerebellar hemispheres are predominantly involve right more than left with a focal lesion that
appears more chronic in the left middle cerebellar peduncle. Small focal lesions are seen within the left occipital lobe as well as within the left basal ganglia head of the caudate nucleus and very tiny one in the left frontal as well as right frontal orbital frontal gyrus, right basal ganglia and right temporal lobe in the region of the amygdala and anterior temporal pole and right frontal opercular
Old right cerebellar infarct is again identified with gliotic changes of the subjacent white matter appears unchanged.
There is again very extensive focal and confluent hyperintensity within the corona radiata with extension into the centrum semiovale consistent with microvascular ischemic changes with involvement now of the splenium of the corpus callosum but without diffusion restriction..
1. Severe progressive microvascular ischemic changes as seen in patient with chronic hypertension and/or diabetes with extensive infra and supratentorial punctate areas of diffusion restriction most likely representing embolic phenomena. Rule out a central cause.