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Leukoaraiosis

Babikian SB - MedPix (2007)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Leukoaraiosis

History: 69 y/o woman with hypertension presents to inpatient service with "left-sided weakness." Yesterday morning she noted that she began dragging her left side. A few hours later the weakness was more obvious and involved her left hand. She had a CT scan that was nonspecifically abnormal because of "cerebral atrophy", but no stroke was seen. She was admitted with a provisional diagnosis of stroke vs. transient ischemic attack. Her right side was not involved. There was no visual loss. There was no facial weakness. She noted that left sided sensations were diminished as compared to the right. She denied a history of strokes. Since that time, she has regained strength in her left leg, however today she noticed a slight slurring of her speech and was unable to lift her arm off the bed. PMH: 1. Hypertension 2. Hyperlipidemia 3. Asthma, mild intermittent 4. Depression 5. Allergic Rhinitis 6. Arthritis MEDS: 1. ASA 81 mg qd 2. Zoloft 100 mg qd 3. Zetia 10 mg qd 4. Zocor 40 mg qd 5. Hyzaar 100/25 mg qd 6. Claritin 10 mg qd 7. Albuterol MDI PRN Social Hx: denies use of tobacco and alcohol Family Hx: unknown

Findings: • MRI Brain: "There is mild, age-appropriate volume loss. There is periventricular and deep white matter symmetric signal abnormality. There is no intracranial hemorrhage, mass, or mass effect. The brain parenchyma, CSF-containing spaces, posterior fossa, limited views of the internal auditory canals and orbits, overlying skull, and soft tissues are unremarkable." • MRA Head w/o contrast: "The circle of Willis is intact. There is no evidence of aneurysm. There is no evidence of vessel occlusion."

Ddx: • Chronic Ischemic Changes • Transient Ischemic Attack • Leukoaraiosis

Dxhow: Imaging and clinical correlation

Exam: Her blood pressure in the ER was 170/101. Vitals: Tm 98.8, BP 134/74, Pulse 66, rr 18 GEN: WDWN AAF in NAD, AAOx3 HEENT: Speech is fluent. No dysartri. Visual acuity, visual fields, and fundi are normal. Pupils and extraocular movements are normal. Mild drooping on left side of face. Cardio: RRR, no clicks, rubs, or murmurs Lungs: CTA b/l, no wheezes, rhales, or rhonchi Abd: Soft, non-tender, non-distended, bowel sounds x4 quadrants, no guarding or rebound. Neuro: Facial sensation on left side are diminished compared to right. No cerebellar findings. Motro: 5/5 Right extremities. 2/5 left arm, 4/5 left leg. Reflexes: 2+ right bicep, tricep, patella, achilles. 3+ left bicep, tricep, patella, achilles, with positive left Babinski Gait: she is dragging her left foot and is unable to walk without aid of the wall Folstein Mini-Mental Status Exam: 30/30 LABS: CBC: WNL Chem7: BUN 24, Creatinine 1.3, otherwise WNL UA: WNL

No MeSH data available.


There is a lack of acute ischemic changes on the HiRes DWI images.
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MPX2390_synpic36486: There is a lack of acute ischemic changes on the HiRes DWI images.


Leukoaraiosis

Babikian SB - MedPix (2007)

There is a lack of acute ischemic changes on the HiRes DWI images.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX2390&req=5

MPX2390_synpic36486: There is a lack of acute ischemic changes on the HiRes DWI images.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Leukoaraiosis

History: 69 y/o woman with hypertension presents to inpatient service with "left-sided weakness." Yesterday morning she noted that she began dragging her left side. A few hours later the weakness was more obvious and involved her left hand. She had a CT scan that was nonspecifically abnormal because of "cerebral atrophy", but no stroke was seen. She was admitted with a provisional diagnosis of stroke vs. transient ischemic attack. Her right side was not involved. There was no visual loss. There was no facial weakness. She noted that left sided sensations were diminished as compared to the right. She denied a history of strokes. Since that time, she has regained strength in her left leg, however today she noticed a slight slurring of her speech and was unable to lift her arm off the bed. PMH: 1. Hypertension 2. Hyperlipidemia 3. Asthma, mild intermittent 4. Depression 5. Allergic Rhinitis 6. Arthritis MEDS: 1. ASA 81 mg qd 2. Zoloft 100 mg qd 3. Zetia 10 mg qd 4. Zocor 40 mg qd 5. Hyzaar 100/25 mg qd 6. Claritin 10 mg qd 7. Albuterol MDI PRN Social Hx: denies use of tobacco and alcohol Family Hx: unknown

Findings: • MRI Brain: "There is mild, age-appropriate volume loss. There is periventricular and deep white matter symmetric signal abnormality. There is no intracranial hemorrhage, mass, or mass effect. The brain parenchyma, CSF-containing spaces, posterior fossa, limited views of the internal auditory canals and orbits, overlying skull, and soft tissues are unremarkable." • MRA Head w/o contrast: "The circle of Willis is intact. There is no evidence of aneurysm. There is no evidence of vessel occlusion."

Ddx: • Chronic Ischemic Changes • Transient Ischemic Attack • Leukoaraiosis

Dxhow: Imaging and clinical correlation

Exam: Her blood pressure in the ER was 170/101. Vitals: Tm 98.8, BP 134/74, Pulse 66, rr 18 GEN: WDWN AAF in NAD, AAOx3 HEENT: Speech is fluent. No dysartri. Visual acuity, visual fields, and fundi are normal. Pupils and extraocular movements are normal. Mild drooping on left side of face. Cardio: RRR, no clicks, rubs, or murmurs Lungs: CTA b/l, no wheezes, rhales, or rhonchi Abd: Soft, non-tender, non-distended, bowel sounds x4 quadrants, no guarding or rebound. Neuro: Facial sensation on left side are diminished compared to right. No cerebellar findings. Motro: 5/5 Right extremities. 2/5 left arm, 4/5 left leg. Reflexes: 2+ right bicep, tricep, patella, achilles. 3+ left bicep, tricep, patella, achilles, with positive left Babinski Gait: she is dragging her left foot and is unable to walk without aid of the wall Folstein Mini-Mental Status Exam: 30/30 LABS: CBC: WNL Chem7: BUN 24, Creatinine 1.3, otherwise WNL UA: WNL

No MeSH data available.