Other speech disturbance(784.59)Clinical question: stroke?Signs and Symptoms: right side weak MRI of the brainThere is a 16x8mm axial dimension focus of diffusion restriction in the left pons associated with T2 and FLAIR signal hyperintensity.There is a mild 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 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 70% stenosis at proximal portion of the intracranial RVA.There is 65% stenosis at the distal opthalmic segment of the RICA.There is 50% stenosis at the distal opthalmic segment of the LICA.There is 40% narrowing of the left PCA at the p2 segment.There is 67% stenosis of the right PCA at the p2 segment.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are tiny. The left vertebral artery is larger than right right vertebral artery.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 no significant stenosis along the course of the left vertebral artery. There is high grade stenosis at the origin of the right vertebral artery.The right vertebral artery is smaller than the left vertebral artery.
1.Acute infarction along the left pons.2.There is high grade stenosis at the origin of the right vertebral artery.3.There is 70% stenosis at proximal portion of the intracranial RVA.4.There is 65% stenosis at the distal opthalmic segment of the RICA.5.There is 50% stenosis at the distal opthalmic segment of the LICA.6.There is 67% stenosis of the right PCA at the p2 segment.7.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 