Diagnosis: Other malaise and fatigueClinical question: r/o acute processSigns and Symptoms: weakness MRI of the brainMultiple small foci of diffusion restriction are present in the territory of the left precentral artery at the left middle frontal and lateral precentral gyri as well as a small portion of the operculum. These are accompanied by FLAIR and T2 signal hyperintensity.A small focus of diffusion restriction is present in the right thalamusThe 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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is extra-cranial origin of the right PICA.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. The RVA is larger than the LVA.
1.Patchy distribution of left precentral artery territory acute cerebral infarction. 2.Small acute cerebral infarction in the right thalamus.3.No evidence for intra-cranial or extra-cranial cerebrovascular occlusive disease is appreciated.