Jon Dorman's Left Hemiparesis Case

The MRI is of a 77 year old Beduoin of the Ras Al Khaimah emirate. 10 days ago he had acute left hemiparesis, slurred speech and drooling. Not shown in this slice is the right hemisphere 2 1/2 cm diameter density alteration in white matter adjacent to the ventricle. The MRI overall was denigrated due to movement. CT scan the day of the event showed nothing acute. He has rather severe cervical spondylosis and we saw him two years ago with neck pain, the left arm and both legs weak (couldn't walk), no change in mentation or speech, felt to be due to the spondylosis (no brain studies done at that time). With cervical traction and walking in a swimming pool (they built him one for this purpose) he began walking again. But a year ago he stopped walking. His mind was said to slip occasionally.

I sent in this T2 saggital demonstrating a white matter alteration I haven't seen before. This was diffuse, bilateral. I call it tapioca-lopathy because of this appearance of little clear ovoids floating in the ground glass. The man has diffuse atherosclerotic change in carotids and circle of Willis vesssels, 50% stenosis bilaterally of carotids. Has anyone seen this appearance before, and what do you think it is?