Clinical question: Rule out stroke. Signs and symptoms: Same. Nonenhanced brain MRI:No evidence of acute intracranial process and in particular no detectable acute ischemic stroke.Very few punctate foci of periventricular nonspecific flair hyperintensity are noted. Although nonspecific considering patient's stated age of 73 this appearance could represent mild degree of chronic nonhemorrhagic small vessel ischemic strokes. The signal intensity of brain parenchyma is otherwise within normal. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination the brain otherwise.On axial T2 series 6 there is abnormal signal intensity right internal carotid artery across the skull base and with a tiny central signal void suggestive of very high grade stenosis of right internal carotid. The supraclinoid right internal remains patent however very small in caliber. The evaluation vascular imaging is highly recommended. Emergency room staff was notified of this finding by the radiology on call resident.12 bilateral vertebral arteries, basilar artery and left internal carotid artery is unremarkable.
1.No detectable acute ischemic process.2.Minimal chronic small vessel ischemic strokes only in the subcortical/periventricular white matter. Unremarkable brain parenchyma otherwise.3.Abnormal signal intensity of the right internal carotid artery across the skull base and with a tiny central signal void highly suggestive of high grade of stenosis. Follow-up with dedicated vascular imaging is highly recommended.