Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: hx of HTN, HLD, CAD, CVA now with weakness History: dysphagia, left sided facial weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.There are multifocal lacunar infarcts involving pons, bilateral thalami, bilateral basal ganglia, bilateral periventricular white matter and the left caudate head. On FLAIR imaging, patch confluent bihemispheric high signal intensity especially around periventricular white matter indicating nonspecific small vessel ischemic disease.On gradient echo, there are multifocal bihemispheric susceptibility lesions indicating prior chronic hemorrhagic foci or calcification. Considering no associated surrounding edema or mass effect, those lesions are assumed to be chronic.There is about 9.5mm x 6.6mm x 9mm sized T1 low signal, T2 slightly high or intermediate signal intensity well marginated lesion in the 4th ventricle without showing any evidence of ventricular enlargement. The lesion is likely represent subependymoma.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Left maxillary sinus fluid collection.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate luminal ectasia with the prominent basilar artery with tortuosity indicating atherosclerotic changes (dolichoectasia). Bilateral distal ICA, MCA and ACAs appear to be normal. Anterior communicating artery is patent, right posterior communicating artery seen but the left posterior communicating artery is not visualized. There is no evidence of intracranial arterial aneurysm. There is no significant luminal stenosis.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate, although tortuous 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. No evidence of acute ischemic or hemorrhagic lesion.2. 9.5mm x 6.6mm x 9mm sized lesion likely represent subependymoma in the 4th ventricle without evidence of hydrocephalus.3. Multifocal chronic ischemic infarction related tissue losses as described above with chronic hemorrhagic foci.4. Moderate to severe non specific small vessel ischemic disease.5. Atherosclerotic changes of both intracranial and extracranial arterial system without evidence of significant luminal stenosis. No intracranial arterial aneurysm was seen. 