56 years Male (DOB:3/23/1960)Reason: Stroke protocol - DWI and MRA ONLY, no perfusion History: L MCA syndrome. Right hemiparesis, right hemisensory loss, aphasia, NIH SSS = 22PROVIDER/ATTENDING NAME: DAVID A HARTER DAVID A HARTER MRI of the brainThere is diffusion restriction involving the left basal ganglia, anterior half of the left insular cortex, an small portions of subcortical white matter in the left inferior and middle frontal gyri, as well as subcentimeter foci in the left temporal and parietal lobes. This diffusion restriction is not associated with significant FLAIR signal hyperintensity. There is intravascular signal hyperintensity in the left operculum and Sylvian fissure. There is SWI left hemispheric transmedullary vein and cortical signal hyperintensityThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A couple punctate foci of FLAIR signal hyperintensity are present in the right internal capsule.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, right middle and posterior cerebral arteries. The left MCA is occluded at its origin.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.Left MCA occlusion.2.Hyperacute infarction involving left basal ganglia, part of the left insular cortex and small foci in the left frontal lobe and to an even lesser degree left parietal and temporal lobes. The clear majority of the left MCA territory is currently spared.3.Hypoxia involving the left MCA territory.4.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 5.Chronic stage lacunar infarcts in the right internal capsule.