 MRI Brain:There are multiple scattered areas of restricted diffusion in the right posterior frontal, right parietal, and right occipital lobes, with associated FLAIR signal abnormality compatible with acute infarcts. Foci of infarcts include the right lateral aspect of the right precentral gyrus. There are multiple additional patchy foci of FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild to moderate chronic small vessel ischemic disease. There is susceptibility effect in the left posterior frontal corona radiata likely representing a prior infarct with chronic blood products. There are additional few scattered punctate foci of susceptibility consistent with chronic microhemorrhages, suboptimally imaged due to motion degradation.There is no significant mass effect, midline shift, or herniation. The ventricles and basal cisterns are normal in size and configuration. There is suggestion of a prior right frontal burr hole craniotomy. There is moderate opacification of the anterior and posterior ethmoid air cells bilaterally.MRA Brain: There is a 1 cm segment of severe stenosis involving the right M1 segment. Evaluation of the remainder of the intracranial arteries is limited secondary to motion degradation. Within these limitations, there is moderate atherosclerotic narrowing affecting the bilateral cavernous portions of the ICAs. The remainder of the ICAs, MCAs or ACAs demonstrate no high-grade stenosis. The right V4 segment is not visible and may be occluded. There is mild to moderate multifocal irregularity involving the left distal vertebral, basilar, and left greater than right posterior cerebral arteries with motion degradation limiting detailed assessment. This study is not adequate to evaluate for small aneurysms. No aneurysm is appreciable within this limitation.
1.Multiple small acute infarcts in the right posterior frontal, right parietal, and right occipital lobes.2.Severe 1 cm segment high-grade stenosis involving the right M1 segment. There is also at least moderate degree of stenosis involving the bilateral cavernous internal carotid arteries. There is also suspected occlusion of the right distal vertebral artery.3.The remainder of the posterior intracranial circulation also demonstrates scattered multifocal irregularity likely related to atherosclerotic disease with motion degradation limiting optimal assessment. Repeat study at 3T with sedation or CTA can be considered as clinically warranted.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.