Reason: stroke History: confusion headacheDOB: 4/30/192788 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR signal hyperintense foci are present in the brainstem, thalami and internal capsules. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Punctate foci of T2 signal hypointensity are present in the left thalamus as well as periventricular white matter.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. The eyeball lenses are thin.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.The anterior communicating artery is identified and is small in diameter. The left A1 segment is slightly larger than the right A1 segment. The posterior communicating arteries are intact. The right posterior communicating artery is small. The left posterior communicating artery is tiny. The left vertebral artery is larger than the right vertebral artery. There is mild narrowing along the intracranial 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. The proximal vertebral arteries are better assessed on the axial MRA of the neck images series #1310 where no stenosis is appreciated along the left vertebral artery course, however, there appears to be narrowing at the origin of the right vertebral artery with a 60%stenosis.
1.There is no evidence for acute ischemic cerebral infarction.2.There is 60% stenosis at the origin of the right vertebral artery.3.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 4.Patchy lesions in the brainstem and thalami are likely vascular related.5.There are microhemorrhages present in the periventricular white matter as well as in the thalami.6.There is no evidence for intracranial cerebrovascular occlusive disease appreciated.