History of TIAs.
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Coronal T2 and axial FLAIR images demonstrate an established/old lacunar infarct in the left centrum semi-ovale. Evidence of Wallerian degeneration with hyperintensity of the left corticospinal tract from centrum semi-ovale through the internal capsule and cerebral peduncle to the level of mid pons. The left corticospinal tract is yet to undergo atrophy.
Wallerian degeneration can be observed following stroke, brain tumor, brain surgery or radiation and trauma. It typically affects the descending corticospinal tract but long association and commissural fibers can also be affected. In the acute phase the affect fiber tract can demonstrate restricted diffusion or enhancement. More typically in the acute and subacute phases the affected fiber tract demonstrates T2 and FLAIR hyperintensities. In the chronic phase the fiber tract will demonstrate atrophy, however, the T2 and FLAIR hyperintensities may persist for months after the initial inciting event.