Female, 83 years old, with left arm and face weakness. Evaluate for stroke. Brain MRI:No restricted diffusion is seen. However, there is extensive patchy periventricular and subcortical white matter T2 hyperintensity. Several superimposed chronic appearing lacunar lesions are seen within the basal ganglia. No edema or mass effect is detected. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collections. Ventricular size and morphology are within normal limits.Brain MRA:Dolichoectasia of the basilar artery is seen. There may be a moderate segmental stenosis of the distal left A2 segment. The PCAs are not well visualized which is felt to be technical in nature. There may be a few additional scattered mild stenoses in the MCA distributions. No aneurysm or vascular malformation is suspected. Neck MRA:Common origin of the brachiocephalic and left common carotid arteries is seen. No significant stenosis is detected in the carotid vessels of the neck by NASCET criteria. No significant stenosis is detected in the vertebral vessels of the neck.
1.No acute ischemia is identified. However, there is evidence of extensive chronic small vessel and lacunar ischemic disease.2.Scattered intracranial stenoses are seen, including a moderate segmental stenosis of the distal left A2 segment. No frank vascular occlusion is identified.3.No significant vascular compromise is detected in the neck.