82 years Male (DOB:2/21/1934)Reason: syncope workup History: near syncopePROVIDER/ATTENDING NAME: NIR Y URIEL NIR Y URIEL MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense focus is present in the brainstem, along the posterior aspect of the pons measures approximately 17 x 15 mm. No abnormal enhancing 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 demonstrate a small mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is 55% stenosis at the origin of the right internal carotid artery and 70% stenosis at the origin of the left internal carotid artery both of which are associated with intraluminal filling defects. The filling defect on the left is larger than the one on the right.The left A1 segment appears hypoplastic . The left internal carotid artery is smaller than the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries.
1.55% stenosis at the origin of the right internal carotid artery and 65% stenosis at the origin of the left internal carotid artery both of which are associated with intraluminal filling defects. The filling defect on the left is larger than the one on the right. It is conceivable that this could represent intraluminal thrombus. Please correlate with the ultrasound findings.2.Periventricular and subcortical white matter lesions of a moderate degree as well as a lesion in the pons are nonspecific. At this age they are most likely vascular related. 