99 years Female (DOB:2/17/1917)Reason: Stroke location History: R side weakness and aphasiaPROVIDER/ATTENDING NAME: DAVID G BEISER KOUROSH X REZANIA MRI of the brainFoci of diffusion restriction are present along the left insular cortex extending to the inferior aspect of the left precentral gyrus. Some punctate foci of diffusion restriction are present in the left centrum semiovale.. A 5 mm focus of diffusion restriction is present in the left temporal lobe.There are patchy foci of encephalomalacia present along the inferior aspects of the cerebellar hemispheres bilaterally.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some patchy lesions which are T2 and FLAIR hyperintense are present in the brainstem. Small T2 and FLAIR hyperintense foci are present in the basal ganglia.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain: Exam is degraded by patient motion artifact.Flow within the basilar artery and the distal left vertebral artery is not readily identified. The right vertebral artery and the left vertebral artery both appear relatively small. The posterior communicating arteries appear to supply the posterior cerebral arteries bilaterally.. There is opacification of the distal basilar artery including the superior cerebellar arteries.The left A1 segment is small. Findings suggest an azygos A2 segment. The left middle cerebral artery vasculature is not as readily visualized is the right middle cerebral artery vasculature. There appears to be divisional occlusion along the left middle cerebral artery territory most likely the inferior division. Is partly obscured by patient motion.
1.Occlusion of the proximal and mid portions of the basilar artery and possibly distal left vertebral artery. The distal basilar artery and the superior cerebellar arteries appear to be supplied from the anterior circulation through the circle of Willis. Please note that the MRA exam is somewhat degraded due to motion artifact. As a result details are less conspicuous. If clinically appropriate and further detail is necessary for clinical management a CT angiogram may be helpful to further evaluate this.2.Findings suggest left middle cerebral artery occlusion at the inferior division. Please note that the MRA exam is somewhat degraded due to motion artifact. As a result details are less conspicuous. If clinically appropriate and further detail is necessary for clinical management a CT angiogram may be helpful to further evaluate this.3.Findings are compatible with acute infarction involving left insular cortex and adjacent aspects of the left centrum semiovale and frontal lobe as well as a small lesion in the left temporal lobe. These are located in the left middle cerebral artery territory.4.Foci of encephalomalacia present along the inferior aspect of the cerebellar hemispheres which are most likely related to prior cerebrovascular event.5.Periventricular and subcortical white matter lesions of a mild degree as well as patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 6.The MRI of the brain exam is limited due to patient inability to cooperate. No susceptibility weighted imaging was performed. No T2 axial or imaging was performed. No axial T1 imaging was performed.