altered mental status There are multifocal various sized restricted diffusion lesions indicating acute ischemic infarctions on bilateral frontal lobes, bilateral parietal lobes, left caudate nucleus, bilateral insular cortex, left basal ganglia, right temporal lobe, right occipital lobe and left cerebellar hemisphere.Patchy high signal intensities on bilateral periventricular white matter on FLAIR images indicate non specific small vessel ischemic disease.Multifocal various sized susceptibility artifacts on bilateral hemispheres indicate amyloid angiopathy but could also represent parenchymal calcifications. However, the possibility of petechial hemorrhage would be low.The ventricles, sulci and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear.3D 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. Acom artery is patent but bilateral Pcom arteries are not seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate mild (about 20%) of luminal narrowing of the left extracranial ICA just above the carotid bulb. The distal right VA is hypoplastic and the left VA is dominant. Otherwise there is no evidence of major arterial occlusion or stenosis.
1. Multifocal acute ischemic infarctions as described above without evidence of hemorrhagic transformation.2. No significant luminal stenosis or occlusion intracranially or extracranially. About 20% of luminal stenosis was seen on the left extracranial ICA just above the bifurcation. 