left side weakness, dysarthria There are focal restricted diffusion on the mid pons (around the right middle cerebellar peduncle) and upper medulla indicating acute ischemic infarction.There are multiple bilateral thalamic susceptibility artifacts on gradient echo images indicating possible microcalcifications or likely chronic petechial hemorrhages. On FLAIR images, there are patchy high signal intensities on bilateral periventricular white matter indicating non specific small vessel disease. Although these patchy high signal intensity lesions are a bit more extensive especially bilateral trigone area, the possibility of white matter disease such as MS is low.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.The right mastoid air cells show opacification.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal bilateral ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin. Vertebrobasilar system shows irregularity of proximal basilar artery without significant luminal stenosis. The left vertebral artery ends up with PICA. The right VA is dominant.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origin appear to be stenotic about 50% but the right vertebral artery appears to be normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Acute ischemic infarction without hemorrhagic conversion on the right mid pons and upper medullar as described above.2. Irregular proximal basilar artery without significant luminal narrowing.3. Hypoplastic left VA with about 50% luminal narrowing on the left vertebral artery origin. Otherwise unremarkable extracranial cervico-carotid arterial system.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.