Diagnosis: Stroke

History: 44yo RHD M with sudden onset of difficulty speaking, L facial droop and drooling. Pt had difficulty forming words, slurred speech, and numbness in L face and arm. Most of the reported symptoms resolved within 10 minutes, with slight numbess and tingling in the L corner of the mouth still present after 30-45 minutes.

Findings: Multiplanar, multi-sequence MRI of brain without IV contrast. Time-of-flight and contrast enhanced MRA of neck and intracranial vasculature with 3D reconstructions. - several small areas of restricted diffusion, two in the right temporal lobe and two in right posterior frontal lobe. Areas have a small amount of associated T2 hyperintensity, most consistent with acute to subacute infarctions. Right frontal lobe lesions are gyroform. DWI shows area of hyperintensity in right cerebral hemisphere No evidence of hemodynamically significant stenosis in the common carotids.

Ddx: Transient Ischemic Attack Focal infection Meningo-encephalitis

Dxhow: MRI of the Brain, MRA of the brain, DWI

Exam: BP: 222/141 HR 108 CN: VII- L side of mouth hangs Vibration mildly decreased equally throughout distal fingers and toes Strength and motor intact Reflexes and coordiantion intact Normal Gait Labs: BUN 28 Cr 3.1