Transient cerebral ischemic attack, unspecified [G45.9], Reason for Study: ^Reason: assess for ischemic changes History: TIA Brain MRIRight centrum semiovale (right parietal white matter) restricted diffusion lesion indicating acute ischemic infarction. No evidence of hemorrhagic conversion.Multifocal patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.There are multifocal chronic ischemic infarct with tissue loss involving bilateral cerebellar hemispheres and the right side of upper pons.Right side medulla shows focal susceptibility lesion indicating hemosiderin deposition or parenchymal calcification.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.Relatively small left maxillary sinus with mucosal thickening indicating possible prior surgery and/or chronic inflammation.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. Vertebrobasilar system appears to be normal. The right PCA is fetal origin.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate 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 not well visualized, thus cannot access precisely.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid. Bilateral vertebral arteries are poorly visualized.
1. Focal acute ischemic infarction at the right side centrum semiovale without evidence of hemorrhagic conversion.2. Chronic ischemic infarctions with tissue losses involving bilateral cerebellar hemispheres and right side of pons.3. Non specific small vessel ischemic disease.4. No evidence of significant (more than 50%) arterial luminal stenosis on both intracranial and extracranial arterial system. No intracranial aneurysm. 