 BRAIN: There is an area of restricted diffusion in the left paramedian pons, with associated T2/FLAIR signal abnormality, compatible with acute infarct. There tiny foci of susceptibility in the right thalamus and right parietal lobe, compatible with chronic microhemorrhages. Mild to moderate scattered periventricular and subcortical T2/FLAIR signal abnormality, likely reflecting chronic microvascular ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There is no evidence of flow-limiting stenosis or aneurysm in the anterior circulation. There is at least moderate stenosis involving the left V4 segment. The right vertebral artery, bilateral PCAs, basilar artery, and cerebellar arteries are patent.MRA NECK: Exam is limited by suboptimal contrast timing. Noncontrast "Inhance" sequence demonstrates a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are slightly narrowed, with additional atherosclerotic mild narrowing of the left subclavian artery. The left vertebral artery is narrow throughout its course, likely reflecting a combination of hypoplasia and atherosclerotic disease. There is moderate stenosis involving the left V4 segment.
1.Left paramedian pontine acute infarct. No acute intracranial hemorrhage is evident.2.Moderate stenosis is suspected involving the left V4 segment, although this is not well assessed. The basilar artery is patent. The left vertebral artery is diffusely small in caliber, likely related to a comminution of hypoplasia and atherosclerotic disease. Further delineation with CT angiography can be considered if clinically indicated. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.