Abnormal findings on diagnostic imaging of other specified body structures [R93.8] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: evaluate for brainstem stroke or mass, was seen by Dr. Arun ( Optho) today and abnormal occular exam Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.Subtle high signal intensity on DWI (series 404, image 176) does not show diffusion restriction, thus likely represent an artifact.Patch bilateral T2/FLAIR high signal intensity lesions are seen, most likely represent nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickening on bilateral maxillary sinuses and ethmoid sinuses.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. There is more than 50% luminal stenosis at the proximal basilar artery just below bilateral AICA origin.The left vertebrobasilar junction also shows more than 50% of luminal stenosis.No intracranial arterial aneurysm is seen.
1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement. 2. Non specific small vessel ischemic disease.3. Proximal basilar artery and left vertebrobasilar junction stenosis (more than 50%) on non contrast MRA. If indicated, more precise imaging evaluation of basilar artery and left vertebrobasilar junction stenosis can be obtained with head and neck CT angiography.