 Brain MRI:There is small focus of restricted diffusion with matching ADC hypointensity within the left thalamus consistent with an acute lacunar infarct.There are foci of T2 hyperintensity within periventricular and subcortical white matter as well as within the pons without restricted diffusion, mass effect, or susceptibility abnormality.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Other than scattered sporadic foci of mucosal thickening, the paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. A previously identified potential focus of hyperdensity within the left MCA on comparison CT demonstrates MRA evident flow. Incidental note is made of bilateral posterior communicating artery origin infundibuli.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.
1.Acute left thalamic lacunar infarct.2.Chronic small vessel ischemic disease.3.Negative MRA of the brain.4.Negative MRA of the neck.