Diagnosis: Unspecified convulsionsClinical question: posterior circulation occlusionSigns and Symptoms: altered mental status 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 small focus of encephalomalacia along the right inferior lobule. There is T2/FLAIR signal hyperintensity associated with local volume loss within the subcortical white matter of the left inferior parietal lobule.There is a small focus of signal loss on SWI within the right temporal lobe adjacent to the temporal horn of the right lateral ventricle. It measures 1.5mm on T2 imaging. There is an adjacent venous structure suspected to represent DVA draining into the right lateral atrial vein.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal 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 small. There is triplication of the ACA. The posterior communicating arteries are small. The vertebral arteries are asymmetric in size. The right vertebral artery is significantly larger than the left vertebral artery. There is extra-cranial origin of the left PICA.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is a small focus of encephalomalacia along the right inferior parietal lobule. One possibility is that this is related to a vascular insult.4.There is an old microhemorrhage in the right temporal lobe. This is associated with a DVA. The lesion is too small to characterize further on this exam.5.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 