 MRI Brain:There is a small focus of restricted diffusion corresponding to the posterior limb of the right internal capsule/right lateral thalamus. This also demonstrates FLAIR signal abnormality and is compatible with an acute infarct. More anteriorly within the right thalamus is a punctate focus of susceptibility abnormality likely indicating a punctate old microhemorrhage. Again seen is moderate periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.MRI C-spine: The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and are appropriate in height. The bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. A cystic structure is noted within the right thyroid region. The paraspinous soft tissue structures otherwise appear within normal limits. Level specific observations:C2-3: Left foraminal disc protrusion and bilateral facet hypertrophy. Moderate left neural foraminal narrowing. No spinal canal stenosis.C3-4: Bilateral facet and uncovertebral hypertrophy. Mild bilateral neuroforaminal narrowing. No significant spinal canal stenosis.C4-5: Bilateral facet and uncovertebral hypertrophy. Moderate right neural foraminal narrowing. No spinal canal stenosis.C5-6: Bilateral facet hypertrophy. Mild bilateral neural foraminal narrowing. No spinal canal stenosis.C6-7 and C7-T1: No significant compromise to the spinal canal or neural foramina.
1.Small acute infarct involving the posterior limb of the right internal capsule/lateral thalamus. No evidence of acute intracranial hemorrhage mass effect, midline shift or herniation.2.No significant flow-limiting stenosis of the major intracranial arteries or arteries of the neck.3.Underlying moderate chronic small vessel ischemic disease.4.Mild degenerative changes involving the cervical spine without appreciable cord signal abnormality or spinal canal stenosis.Findings were discussed with the neurology resident on call Dr. Quaynor (pager 1769) at the time of the preliminary entry at 1600 on 9/14/2016.