Diagnosis: Muscle weakness (generalized)Muscle weakness (generalized)Diagnosis Edits: Clinical question: r/o acute ischemic infarctSigns and Symptoms: right sided weaknessComments: GFR =14 MRI of the brainThere is a focus of diffusion restriction centered along the posterior limb of the left internal capsuleThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Similar lesions are also present along the brainstem.Punctate foci of SWI signal loss are present in the right cerebellum and right thalamus. 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 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, middle and posterior cerebral arteries.The right ICA is smaller compared to the left ICA throughout its course. The right A1 segment is smaller than the right A1 segment. There is a 2.5 mm ACOMA aneurysm present.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:The great vessel origins from the aortic arch and the aortic arch are not included on this exam. There is irregular stenosis at the proximal right ICA associated with decrease in caliber along the cervical right ICA. This suggests a >70% stenosis at the proximal right ICA. The imaging is somewhat degraded by pulsation. On the basis of NASCET criteria there is no significant stenosis at the left carotid bifurcation. There is no significant stenosis along the course of the vertebral arteries.
1.There is a small acute cerebral infarction centered along the left posterior limb of internal capsule.2.Findings suggest a >70% stenosis at the proximal right ICA. It is not adequately imaged on this exam. Additional investigation with CTA or with ultrasound may be of further benefit.3.There is a 2.5mm ACOMA aneurysm present.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.Punctate lesions in the brain stem and thalami are likely related to prior lacunar infarcts.6.Microhemorrhages are present in the right cerebellum and the right thalamus. They are non-specific but could relate to hypertension.