There are areas of T2 and FLAIR hyperintense signal and restricted diffusion at the paramedian sectors of the thalami as well as in the median-paramedian and periaqueductal grey matter of the midbrain and along the pial surface of the midbrain interpeduncular fossa (the V-sign). Infarct in the Percheron’s territory is clearly demonstrated.
There are some small foci of restricted diffusion in the occipito-mesial region and at the right frontal lobe, in which focal cortical laminar necrosis is also present characterized by an intrinsic high T1 signal and corresponding susceptibility artifact. Old infarcts are also demonstrated in the parietal lobes. Some chronic ischemic changes of small vessels in the supratentorial white matter and at the middle right cerebellar peduncle are also evident. Discrete deposition of iron at the basal ganglia, red nuclei and dentate nuclei is appreciated. The ventricular system, the cerebrospinal fluid spaces and the basal cisterns are moderately dilated.