Slurred speech [R47.81], Reason for Study: ^Reason: stroke workup History: dysarthria Brain MRIThere are scattered multiple diffusion restriction on the left precentral gyrus indicating acute ischemic infarct. There is no evidence of hemorrhagic transformation.There are also increased FLAIR/T2 high signal intensity lesion with tissue loss on the right inferior parietal lobule, in particular supra marginal gyrus as well as left cerebellar hemisphere indicate chronic ischemic infarct with encephalomalacia.Scattered and somewhat patchy T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale 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. 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 normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left vertebral artery and is with left PICA.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate 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. Left vertebral artery appears to be hypoplastic.
1. Acute ischemic infarct without evidence of hemorrhagic transformation on the left MCA territory, left frontal lobe precentral gyrus.2. Chronic ischemic infarct with encephalomalacia on the right MCA territory, inferior parietal lobule as well as left cerebellar hemisphere. 3. Nonspecific small vessel ischemic disease.4. No evidence of luminal stenosis, major vessel occlusion on post intra and extra cranial arterial system.5. No evidence of intracranial arterial aneurysm.