Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: r/o stroke, evaluate for demyelination History: acute left sided weakness, questionable dx of MS Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There scattered tissue losses involving bilateral caudate nuclei, thalami, pons and centrum semiovale indicate chronic lacunar infarctions. Underlying brain shows multifocal patchy T2/FLAIR high signal intensity lesion on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia.The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 40% of luminal stenosis at the level of proximal right MCA M1 segment. Due to vascular tortuosity, the MIP image of the MRA shows exaggerated the degree of stenosis. Otherwise unremarkable bilateral ACAs and left MCA. There is less than 10% of luminal narrowing at mid basilar artery. And the right distal vertebral artery is small which may indicate congenital hypoplastic artery. Right Pcom artery and Acom artery are patent. The left Pcom artery is not seen.There is no evidence of intracranial arterial luminal stenosis. No intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, and internal/external carotid arteries. The right vertebral artery is hypoplastic and the left vertebral artery is dominant.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal lacunar infarctions with underlying non specific small vessel ischemic disease.3. About 40% of luminal stenosis of the proximal right MCA M1 segment and less than 10% luminal stenosis at the mid basilar artery. No other intracranial and extracranial arterial luminal stenosis. No intracranial aneurysm. 