Cerebral infarction due to unspecified occlusion or stenosis of right posterior cerebral artery [I63.531], Reason for Study: ^Reason: assess for stenosis History: right PCA ischemic infarct 54 years Female (DOB:7/9/1962)Reason: assess for stenosis History: right PCA ischemic infarctPROVIDER/ATTENDING NAME: THOMAS L. FISHER Brain MRIThere are diffusion restriction lesions involving the right posterior temporal and occipital lobes. On gradient echo images, there are susceptibility lesions within the right occipital lobe lesion indicating petechial hemorrhagic transformation.Subtle enhancement within the diffusion restricted lesions indicate luxury perfusion, again indicating acute to subacute ischemic infarction.Multiple scattered T2/FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal. 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. Basilar artery is small and the left vertebral artery ends up with the left PICA. There is no evidence of intracranial arterial aneurysm. There is no evidence of significant (more than 50%) intracranial arterial luminal stenosis. Neck MRA4D 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.
1. Right posterior temporal and occipital lobe acute or subacute ischemic infarction, right PCA, with petechial hemorrhagic conversion.2. Bilateral fetal origin PCAs. Small basilar artery with the left vertebral artery ends up with PICA. No aneurysm. No significant (more than 50%) intracranial arterial stenosis.3. Normal Neck MRA. 