Reason: Evaluate for PCA stroke History: Persistent dizziness, nausea, and vomiting1/11/194967 yearsFemale MRI of the brainOn diffusion-weighted imaging some subtle signal hyperintensity projecting along the thalami and centrum semiovale and frontal lobes is most likely related to artifact.Examination is mildly degraded due to patient motion.The 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.On T2 and FLAIR MRI there is a high signal intensity focus involving the posterior limb of the right internal capsule extending to the right centrum semiovale. There are punctate T2 and FLAIR hyperintense foci present in the brainstem and thalami.On susceptibility weighted imaging there are multiple punctate and medium-sized foci of signal loss throughout the brainstem and thalami.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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. 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 a 2 mm aneurysm present along the distal right internal carotid artery at the origin of the right posterior communicating artery.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 very small. The vertebral arteries are similar in size.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. A weblike defect present within the proximal left internal carotid artery is suspected to be artifactual .
1.A weblike defect present within the proximal left internal carotid artery is suspected to be artifactual , however, it does give the appearance of the dissection flap. As a result of follow-up exam such as ultrasound or CT angiography may be of further benefit to help confirm this is an artifact.2.Findings are suggestive of a 2 mm aneurysm at the right posterior communicating artery origin. This can be confirmed via CT angiography.3.There are multiple microhemorrhages present throughout the brainstem and thalami whose pattern suggests these are associated with hypertension.4.Findings are compatible with an old lacunar infarct in the right posterior limb of internal capsule.5.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 