Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval for vascular abnormality History: syncope, gait instability Brain MRIMotion artifacts degraded exam quality.Especially gradient echo images (venbold) are non diagnostic/There is no evidence of acute ischemic lesion.Patchy FLAIR high signal intensity lesions on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifacts significantly degraded image quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate patent ICAs, MCAs and ACAs. Vertebrobasilar system appears to be patent.Due to significant motion artifacts, precise evaluation of intracranial arterial system for atherosclerotic changes, mild to moderate luminal stenosis or arterial aneurysm cannot be evaluated.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 80% or higher degree of luminal stenosis on the left carotid bulb and distal left CCA.Bilateral distal vertebral arteries at the level of C1 show about 50% luminal stenosis.Left vertebral artery ostium appears to have more than 70% luminal stenosis. The right CCA and extracranial ICA do not show any significant luminal stenosis.
1. Motion artifacts degraded exam quality.2. No evidence of acute ischemic lesion. 3. Non specific small vessel ischemic disease.4. More than 80% stenosis of the distal left CCA and left CCA bulb as described above.5. Various degree luminal stenosis of bilateral distal vertebral arteries and left vertebral artery ostium as described above. 