70 years Female (DOB:11/3/1945)Reason: stroke evaluation History: L leg weaknessPROVIDER/ATTENDING NAME: RAYMOND ROOS JAMES A. MASTRIANNI MRI of the brainThere are punctate foci of diffusion restriction present along the inferior aspect of the right cingulate gyrus adjacent to and involving the corpus callosum. Additionally couple punctate foci are present along the right paracentral lobule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are small foci of encephalomalacia in the right centrum semiovale.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 no evidence for intracranial aneurysm or cerebrovascular occlusion. There are mild foci of narrowing along the carotid siphon bilaterally but no significant stenosis or occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is smaller than the left A1 segment. There is fetal origin of the right posterior cerebral artery with a hypoplastic right P1 segment. The left posterior communicating artery is not readily identified. The vertebral arteries are similar in size.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 vertebral arteries, however, the origins of the vertebral arteries are not adequately imaged due to artifact. The origins of the vertebral arteries are mildly tortuous. There is only mild atherosclerotic narrowing at the left common carotid artery at the bifurcation.
1.There are multiple acute to subacute microinfarcts present along the distribution of the right pericallosal artery.2.There is no intracranial cerebral vascular occlusion appreciated.3.Small foci of encephalomalacia in the right periventricular white matter suspected to be related to prior vascular events4.Multiple foci of atherosclerotic narrowing are present in the carotid artery distribution without significant stenosis5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 