Reason: Evaluate for ischemic stroke or mass lesion History: sudden onset of confusion and unresponsiveness, nonverbal but eyes open, not following any commands MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable since prior exam.There is a mild degree of brainstem punctate hyperintense lesions present identified on the FLAIR and T2 images. This is stable since prior exam.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. It is suspected that an apparent narrowing of the right internal carotid artery at the petrous segment is in part exaggerated due to artifact from adjacent air interface.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. The right A1 segment is hypoplastic. The posterior communicating arteries are very small. The right vertebral artery is larger than the left vertebral 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 no significant stenosis along the course of the vertebral arteries.
1.No evidence for acute ischemic cerebral infarction.2.No convincing evidence for significant intracranial or extracranial cerebrovascular occlusive disease. There is apparent narrowing of the right internal carotid artery at the petrous segment which may be exaggerated due to artifact.3.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. This is stable since prior exam.4.A mild degree of brainstem lesions are also suspected to be vascular related. This is stable since prior exam.