Other musculoskeletal symptoms referable to limbs(729.89) [729.89] / Dysphagia, unspecified(787.20) [787.20], Reason for Study: ^Reason: see MRA/MRI History: as above There is evidence of restricted diffusion on the left middle cerebral peduncle and anterior inferior aspect of the left cerebellar hemisphere indicating left AICA territorial ischemic infarct. There is no evidence of hemorrhagic transformation.Scattered high signal intensities on periventricular white matter on FLAIR imaging indicating nonspecific small vessel ischemic disease, minimal degree.The ventricles, sulci and cisterns are symmetric and unremarkable.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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate tight stenosis on the proximal basilar artery where the right AICA arises but the left AICA is not seen. The distal right vertebral artery completes with the right PICA. Left PICA is not seen. Bilateral intracranial internal carotid arteries shows tortuosity but without significant (more than 50%) luminal stenosis. No definite evidence of intracranial arterial aneurysm was seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate slightly smaller left internal carotid artery comparing to that of right with a subtle linear low intensity across the carotid bulb. Therefore, the diagnostic possibilities of relatively smaller size of the left internal carotid artery include normal variation, and secondary changes due to proximal extracranial cervical segment vascular web. If clinically indicated, CT angiography of the neck could be considered. Right common carotid and extracranial internal carotid as well as bilateral vertebral arteries appear to be normal.
1. Acute ischemic infarct on the left ACA territory without evidence of hemorrhagic conversion. 2. Tight stenosis of proximal basal artery on the origin of the right AICA, the left ACA is not seen. 3. Atherosclerotic changes of intracranial arterial system.4. Relatively smaller luminal diameter of the left extracranial internal carotid artery, diagnostic possibilities include normal variation and proximal arterial web related secondary changes.