Other specified disorders of muscle [M62.89], Reason for Study: ^Reason: stroke w/u History: L sided weakness and neglect, R gaze deviation. Brain MRIScattered multiple restricted diffusion lesions on the right frontal, temporal lobes and insular without evidence of hemorrhagic transformation indicating acute ischemic infarct.Underlying brain shows multifocal FLAIR high signal intensity lesions on white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, 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 paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 50% luminal stenosis at the proximal basilar artery just after the right AICA origin. Otherwise there is no evidence of intracranial arterial luminal stenosis or intracranial aneurysm. There are luminal irregularities at the distal right vertebral artery without significant luminal stenosis. Bilateral PCAs are fetal origin. Acom artery is patent.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate suspicious arterial luminal stenosis of more than 70% with post stenotic dilatation. However, due to motion artifacts, image quality has bee significantly degraded.The left CCA and extracranial ICA appears to be unremarkable.Right vertebral artery is hypoplastic and the left vertebral artery is dominant. Vertebral ostium on the left side appears to be normal but the right side cannot be evaluated due to artifacts. Brachiocephalic artery, right CCA and proximal left subclavian artery cannot be evaluated due to artifacts related poor image quality.
1. Acute ischemic infarctions without hemorrhagic transformation at the right frontal, temporal lobes and insular.2. Possible significant luminal stenosis at the proximal right extracranial ICA just above the bifurcation as described above. 3. About 50% of luminal stenosis at the proximal basilar artery with irregularities of the distal right VA. Otherwise unremarkable brain MRA.Rec: CT angiography of head and neck can be considered for further imaging evaluation.