Diagnosis: Dizziness and giddinessClinical question: repeated episodes of vertigo may have been caused by posterior circulation compromise 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 are several subcortical and periventricular white matter lesions which are hyperintense on T2 and FLAIR MR imaging. Given their small number there are of little clinical significance.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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The left vertebral artery is smaller than the right vertebral artery. There is extracranial origin of the right posterior inferior cerebellar artery.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. There likely of little clinical significance given their small number. Several subcortical and periventricular white matter lesions are frequently seen in this age group.4.A small left vertebral artery is present intracranially. This could be variation of normal.