Syncope and collapse [R55], Reason for Study: ^Reason: eval SDH, eval ischemic cerebellar infarct History: falls Brain MRI:There are restricted diffusion lesions on the right side posterior inferior cerebellar hemisphere without evidence of hemorrhagic transformation indicating right PICA territorial acute/subacute ischemic infarction.Patchy high signal intensity lesions on mid pons, centrum semiovale and bilateral periventricular white matter indicate age indeterminate non specific ischemic lesions.The ventricles, sulci and cisterns are symmetric and 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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.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. Bilateral PCAs are fetal origin.The distal right vertebral artery is faintly shown. This could represent hypoplastic or stenosis.The right PICA is not seen but the left PICA is demonstrated.Basilar artery appears to be small in diameter, however, considering bilateral fetal PCAs, the size is appropriate.There is no evidence of large vessel occlusion or significant luminal stenosis.There is no evidence of intracranial arterial aneurysm.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 normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. The distal right vertebral artery is faintly visualized and the left vertebral artery appears to be dominant.
1. Right PICA territorial acute/subacute ischemic infarction without evidence of hemorrhagic transformation.2. Non specific small vessel ischemic disease.3. The right vertebral artery diameter is smaller than that of the left vertebral artery and the distal right vertebral artery is faintly visualized. The right PICA is not visualized. Subtle irregularity of basilar artery and bilateral MCAs indicate minimal to mild intracranial atherosclerosis.4. No intracranial arterial aneurysm. No intracranial arterial luminal narrowing or occlusion. Bilateral carotid bifurcation appear to be normal.