79 years Male (DOB:1/26/1937)Reason: r/o Infarct History: DysphagiaPROVIDER/ATTENDING NAME: MICAH T PROCHASKA MICAH T PROCHASKA Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The exam is degraded due to motion artifact. Overall the patient's spinal cord appear small and atrophicAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this levelAt C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disc protrusion present at this levelAt C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a left paramedian disc protrusion present at this level without significant compromiseAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.MRI of the brainNo diffusion weighted abnormalities are appreciated. Exam is degraded due to motion artifact.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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. The eyeball lenses are 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.The left middle meningeal artery is fairly prominent and larger compared to the right middle meningeal artery.Findings suggest a 1.5 mm right middle cerebral artery bifurcation aneurysm which is directed superiorly.There is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is very small. The anterior communicating artery is small The left vertebral artery is slightly larger than the right vertebral 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.
1.The patient's spinal cord is small and atrophic.2.The left middle meningeal artery is large. There is a nonspecific finding but could relate to vascular lesion which supplies or represent a variant of normal. Please correlate with patient's clinical symptoms3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.The exams are degraded by motion artifact which will obscure more subtle abnormalities.5.There is no evidence for acute ischemic cerebral infarction