Diagnosis: WeaknessClinical question: r/o strokeSigns and Symptoms: r/o stroke MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. 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.Exam is limited by motion artifact.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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are intact and are fairly large. The vertebral arteries are similar in size.Exam is limited by patient motion artifact.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. 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. The origins of the great vessels from the aortic arch are not well visualized. Similarly the origins of the vertebral arteries from the subclavian arteries are not well visualized. To the extent of visualization possible there is no significant stenosis appreciated at the origins of the great vessels from the aortic arch. The origin of the left vertebral artery in particular is obscured by artifact and the course of the left vertebral artery appears rather attenuated.Exam is limited by patient motion artifact.
1.There is no evidence for acute ischemic cerebral infarction present.2.The left vertebral artery is suboptimally visualized. It is quite possible that this nonvisualization suggests disease involving the left vertebral artery. A CT angiogram may be of further benefit in evaluating this.3.No evidence for intracranial cerebrovascular occlusive disease.4.Examination is somewhat limited due to patient motion which may obscure more subtle abnormalities.