66 years Male (DOB:2/5/1950)Reason: rule out stroke History: L facial droop, dysarthriaPROVIDER/ATTENDING NAME: JAMES J. WALTER DAVID G. BEISER MRI of the brainPatchy foci of diffusion restriction are present in the right centrum semiovale, body of the caudate nucleus and lateral aspect of the precentral gyrus with some punctate foci of diffusion restriction in the right parietal lobe. There is associated T2 and FLAIR signal hyperintensity with the diffusion restriction.The right medullary veins and cortical veins are asymmetrically larger compared to their left sided counterparts.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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:The right MCA is occluded at its origin.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is ACA triplication with a median artery. There is fetal origin of the left PCA. The left P1 segment is small. The right PCOMA is not readily visualized. The right vertebral artery is small.
1.Right MCA occlusion at its origin.2.Subacute infarction along the right MCA territory as detailed above3.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 