Weakness [R53.1], Reason for Study: ^Reason: r/o ischemic stroke History: right arm weakness and slurred speech Brain MRI:There is a focal high signal intensity on the left parietal operculum which shows high signal intensity on diffusion-weighted imaging with equivocal restricted diffusion on ADC map, the lesion shows mild increased signal intensity on T2 weighted image, best seen on coronal T2-weighted image series #7 image #24. This lesion indicate either late subacute or early chronic ischemic infarct.There are linear and nodular susceptibility artifacts on the right frontal lobe indicating hemosiderin differentiation possibility due to prior localized subarachnoid hemorrhage.Underlying brain shows multiple patchy high signal intensity FLAIR lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.Otherwise there is no evidence of new acute ischemic or hemorrhagic lesion on the scan.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. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate less than 50% focal luminal narrowing on the left MCA distal M1 segment.There are multifocal intracranial arterial luminal narrowings on bilateral distal MCAs and PCAs indicating intracranial atherosclerosis without evidence of significant (more than 50%) luminal stenosis.The right ACA A1 segment and distal left vertebral artery are hypoplastic.There is no intracranial arterial aneurysm.
1. Equivocal restricted diffusion with slightly increased T2 signal intensity on the left parietal operculum indicate late subacute or early chronic ischemic infarction without hemorrhagic transformation. 2. Nonspecific small vessel ischemic disease.3. Focal but less than 50% of luminal narrowing on the left MCA distal M1 segment.4. Intracranial atherosclerosis as described above without evidence of significant luminal stenosis.