Male, 27 years old, with bilateral ischemic infarcts. Assess for vascular stenosis. Also with radiculopathy/plexopathy of the right lower extremity was lower motor neuron and upper motoneuron signs. MRA Neck:Conventional aortic branching is seen. The origins of the great vessels are patent. No significant vascular stenosis is seen within the carotid circulation of the neck by NASCET criteria. No significant stenosis is seen within the vertebral vessels of the neck. The left vertebral artery is dominant.MRA Head:No evidence of significant vascular stenosis or occlusion is seen. No aneurysms or other vascular abnormalities are detected. The right vertebral artery appears to terminate in the right PICA, an anatomic variation.Lumbar spine:T2 hyperintensity and edema affects the right iliacus and iliopsoas muscle bundles. On postcontrast images, small areas of rim enhancement with central hypoenhancement are seen within the iliopsoas musculature. The adjacent marrow of the iliac bone, however, shows normal signal intensity and is free of pathologic enhancement.Mild T2 hyperintensity also affects the obturator and abductor muscles of the right hip, and to a lesser degree the right gluteal muscles. A small amount of tracking fluid is evident within the right retroperitoneum. T2 hyperintensity is also seen within the subcutaneous tissues along the right hip and flank.Although the nerve roots of the lumbar plexus do pass in proximity to the abnormal musculature as discussed above, no discrete nerve lesion is appreciated on this examination. The visualized spinal cord, conus and nerve roots of the cauda equina are within normal limits. No pathologic intramedullary or leptomeningeal enhancement is seen.Lumbar spine alignment is anatomic. Vertebral body morphology is normal. No pathologic marrow signal abnormality or enhancement is seen.The intervertebral disks are preserved with no evidence of significant bulging or herniation. No spinal canal or neuroforaminal stenosis is appreciated.
1.Soft tissue and musculoskeletal injury is seen involving the structures of the right hip girdle as discussed above. Small areas of rim enhancement within the iliopsoas musculature are favored to represent muscle fiber injury with perhaps a small amount of blood product. Infection is not excluded but is considered less likely, particularly in the absence of any clinical or laboratory evidence. Overall, these findings are of uncertain etiology but could be traumatic and related to seizure and fall. A myositis of some other etiology may also be considered.2.No discrete injury to the nerves of the lumbar plexus is suspected. However, these nodes do traverse in proximity to the injured hip musculature and as such they may be affected by the adjacent inflammation.3.The lumbar spine itself is unremarkable with no evidence of osseous injury or significant spinal canal or neuroforaminal stenosis.4.Unremarkable MRA evaluations of the head and neck.