Cerebrovascular disease, unspecified [I67.9], Reason for Study: ^Reason: stroke History: left leg weakness Brain MRIThere is a restricted diffusion on the right internal capsule posterior limb indicate acute ischemic infarct. In addition, the ischemic infarction is associated with focal internal susceptibility lesions which may indicate focal hemorrhagic conversion. However, since there are multiple bihemispheric brain parenchymal susceptibility lesions which indicate possible mineralizations or hemosiderin depositions, simple association of susceptibility lesions within acute ischemic infarct area cannot be completely excluded.Underlying brain shows patch bilateral periventricular T-2/flair high signal intensity lesions indicating nonspecific small vessel ischemic disease.There are lacunar infarcts involving right mesial posterior inferior thalami and the right frontal white matter. In addition, there is a chronic ischemic infarct related encephalomalacia on the left temporoparietal lobe.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal variable degree intracranial arterial luminal stenosis involving bilateral MCA distal M1 segment as well as M2 segment. In particular, right MCA genu portion and left MCA M1 segment before the bifurcation shows about 70-80% shows about 90% of luminal stenosis. There is no evidence of intracranial arterial aneurysm. Vertebrobasilar system shows tortuous course but without arterial luminal stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate slightly ectatic and tortuous course, however, normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Focal acute ischemic infarct involving right internal capsule posterior limb with possible internal hemorrhagic conversion.2. Multifocal bihemispheric brain parenchymal susceptibility lesions indicating either parenchymal mineralization or hemosiderin deposition. 3. Intracranial atherosclerosis with multifocal various degree arterial luminal stenosis. In particular, bilateral MCA M1 segments show more than 70% of luminal stenosis.4. Tortuosity of extracranial arterial system indicate atherosclerotic changes. However, there is no evidence of arterial luminal narrowing or occlusion. 