77 years Female (DOB:9/7/1938)Reason: r/o ischemic stroked History: hx of CVA, AMS, focal neurological deficitsPROVIDER/ATTENDING NAME: MARDI I GOMBERG-MAITLAND MARDI I GOMBERG-MAITLAND MRI of the brainThere are several foci of diffusion restriction present. One is located in the left centrum semiovale in the frontal lobe. One is located in the right postcentral gyrus subcortical white matter a few more scattered in the right centrum semiovale posteriorly, one in the right occipital lobe subcortical white matter in the couple in each of the temporal lobe as well as one in the right lower midbrain and a couple are located in the left half of the splenium of the corpus callosum.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. There are multiple punctate foci of susceptibility effect in the thalami, periventricular white matter, subcortical white matter, cerebral peduncles and brainstem.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 demonstrate opacities left and to lesser degree right mastoid air cells. The visualized portions of the orbits are intact. The right eyeball lens is thin.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 and is medium size. The left A1 segment is fenestrated. The right posterior communicating artery is relatively small but can be identified. The left posterior communicating artery is medium-sized.. The right vertebral artery is larger than the left vertebral artery. There is extracranial origin of the right posterior inferior cerebellar 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. The thyroid gland is large and heterogeneous
1.There are multiple microinfarcts scattered throughout the brain in multiple vascular territories both anterior and posterior circulation.2.Periventricular and subcortical white matter lesions as well as lesions in the brainstem and cerebellar hemispheres of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.There are multiple microhemorrhages present which the large degree could be hypertensive in nature but are nonspecific.4.The thyroid gland is large and heterogeneous suggesting a goiter..