Muscle weakness (generalized)Unspecified ptosis of eyelid. Paralytic strabismus, fourth or trochlear nerve palsyL ptosis, L leg weakness, L-sided sensory deficit since this amevaluate steno-occlusive disease.Mild nonproliferative diabetic retinopathy MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2 and FLAIR sequence hyperintense focus centered in the left centrum semiovale measuring 15x6mm axial dimensions as well as several punctate foci of signal hyperintensity in the left frontal and parietal subcortical white matter and left sided periventricular white matterNormal 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 demonstrate minor opacities. 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. The left A1 segment is small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is medium sized. The left posterior cerebral artery has fetal origin. The left p1 segment is medium sized. The vertebral arteries are similar in size. There is extracranial origin of the left 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 LCCA originates from the innominate artery.
1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.There is lesion in the left centrum semiovale associated with several punctate lesions in the left periventricular and subcortical white matter which are most likely vascular related possibly from prior small ischemic event now in a chronic stage.