Reason: intracranial stenosis History: right face and left arm weakness MRI of the brainThere are five to eight 2-8 mm size foci of diffusion restriction are present along the right precentral and postcentral gyri. There are a couple 2mm sized foci of diffusion restriction along the right precuneus and cuneus.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional similar appearing lesions present in the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is approximately 40% narrowing of the mid basilar artery.There is mild narrowing at the origins of the superior and inferior divisions of the right middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is small The posterior communicating arteries are not readily visualized. The left vertebral artery is very small.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 no significant stenosis at the carotid bifurcations. There is high-grade stenosis present the origin of the left vertebral artery. Left vertebral artery is small compared to the right vertebral artery throughout its cervical course.
1.Small foci of acute infarction are present in the right parietal lobe, right pre-and postcentral gyri and right occipital lobe. The vascular distributions include right posterior cerebral artery territory and the right middle cerebral and territory. The posterior communicating arteries are tiny.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the pons and midbrain are most likely vascular related.4.There is mild narrowing at the origins of the superior and inferior divisions of the right middle cerebral artery.