Other visual disturbances [H53.8], Reason for Study: ^Reason: vasculitis? History: neuro deficit Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Left side basal ganglia including external capsule shows encephalomalacia with gliotic changes indicating chronic ischemic infarct, unchanged since prior scan.The left lateral ventricle shows ex vacuo changes, otherwise unremarkable.There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifact degraded exam quality. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate irregular and small diameter of the left internal carotid artery with nonvisualization of left ACA A1 segment. Normal appearance of right ICA, MCA and ACA. Vertebrobasilar system appears to be normal. Comparing to prior scan obtained on Dec 26 2014, the intracranial portion of the left ICA especially from the level of the carotid canal appear to be recanalized. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non visualization of the left CCA. Extracranial left carotid system is visualized at the level of carotid bifurcation with demonstration of small caliber both ICA and ECA branches.Left subclavian artery proximal portion is not demonstrated either but reconstituted at the level of left vertebral artery origin.The brachiocephalic artery also shows significant luminal stenosis.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarction on the left basal ganglia and external capsule.3. Multifocal both intra and extracranial arterial luminal stenosis involving brachiocephalic artery and left intracranial ICA especially cavernous sinus segment. There is also complete occlusion of the left CCA and left subclavian artery origin. These findings may suggest idiopathic arteritis such as Takayasu's disease or vasculitis. 4. Interval recanalization of the left ICA intracranial portion.Rec: Considering the feature of both extracranial and intracranial arterial system which suggest possibility of vasculitis, brain MRI with and without contrast enhancement to assess any intracranial inflammatory foci can be considered if clinically indicated. 