Clinical question: Progression of stroke. Signs and symptoms: Bilateral weakness. Nonenhanced brain MRI:Examination is performed in limited fashion based on recommendation from clinical services due to patient's condition. Only diffusion-weighted and axial flair images were acquired.Diffusion weighted images redemonstrate a nonhemorrhagic subacute left aica and PICA ischemic stroke involving the left cerebellum and vermis with associated mass effect on the fourth ventricle. There is mild interval increase in the extent of stroke with further extension into the left cerebellum inferiorly and the tiny small new additional noncontiguous foci of restricted diffusion in the left cerebellum, vermis and a tiny focus in the right cerebellar. Additionally there are new small foci of restricted diffusion involving the left occipital lobe involving the cortex and subcortical white matter. The larger focus of restricted diffusion in the left occipital lobe measures at 25 x 8 mm in transaxial dimensions.Findings are not associated with any hemorrhagic changes.Above findings aren't well identified on axial FLAIR sequence as well. Additionally examination redemonstrates previously known mild chronic nonhemorrhagic small vessel ischemic strokes only in the periventricular and subcortical white matter of cerebral hemispheres.Nonenhanced brain MRA:Bilateral internal carotid arteries remain widely patent across the skull base and in their supraclinoid segments. Bilateral anterior and middle cerebral arteries demonstrate any significant vascular compromise or distal vascular occlusion. No change since prior exam.The vertebrobasilar system redemonstrated without interval change a short segmental high-grade stenosis immediately superior to the origin of the right AICA are unchanged. There is poor visualization of right Aica and nonvisualization of the left similar to prior exam. Basilar artery superior to this stenosis remains patent and bilateral superior cerebellar arteries and posterior cerebral arteries are patent.A hypoplastic uniformly small right vertebral artery and right I, branch are identified. A very small caliber right vertebral artery terminates into the basilar artery which can be appreciated only on source images.
1.Interval increased extent of left cerebellar subacute nonhemorrhagic ischemic stroke and with multiple new small additional noncontiguous foci of acute ischemic stroke in left cerebellum and left occipital lobe and a tiny focus in the right cerebellum. No evidence of hemorrhage and only mild mass effect upon the fourth ventricle.2.MRA of intracranial circulation demonstrate no definitive evidence of any new finding since prior study from 6-30-15. High-grade stenosis of the proximal basilar artery and absence of the left AICA and left PICA as detailed above. Hypoplastic right vertebral artery remains patent and the visualization of the right PICA branch. Patent bilateral internal carotid, anterior and middle cerebral arteries.