72 years Female (DOB:4/5/1944)Reason: 2 temporary episodes of loss of vision in R eye, brief episode of temporal pain History: 2 temporary episodes of loss of vision in R eye, brief episode of temporal painPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate a small air-fluid level in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small size. There is fetal origin of the posterior cerebral arteries bilaterally with moderate-sized right P1 segment and a hypoplastic left P1 segment. The right vertebral artery is hypoplastic distally and predominantly supplies the right posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is approximately 40% narrowing at the origin of the right internal carotid artery. There is no significant stenosis along the course of the left vertebral artery. There is a stenosis at the origin of the right vertebral artery.The left common carotid artery originates from the innominate artery.
1.There is a stenosis at the origin of the right vertebral artery which is hypoplastic intracranially.2.There is no evidence for acute ischemic cerebral infarction.3.There is 40% narrowing at the origin of the right internal carotid artery.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Air-fluid level in the left maxillary sinus is nonspecific. The possibility of acute sinusitis, however, cannot be excluded. Please correlate with patient's clinical symptoms.