Slurred speech [R47.81], Reason for Study: ^Reason: ? Stroke History: slurred speech, RLE weakness There are localized restricted diffusion lesions on the left side of pons indicating acute ischemic infarct. There is no evidence of hemorrhagic conversion. Localized T2/flair high signal intensity lesions on the left external capsule right thalamus indicating lacunar infarctions.Underlying brain shows scattered T2/flair high signal intensity lesions on periventricular white matter indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. 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 multifocal intracranial arterial luminal stenosis. Among them, the distal left internal carotid artery just above the posterior communicating artery origin and mid basal artery demonstrate more than 50% of luminal stenosis.There is no evidence of intracranial aneurysm.
1. Left pontine acute ischemic infarct without evidence of hemorrhagic conversion.2. Nonspecific small vessel ischemic disease and scattered lacunar infarctions.3. Multifocal intracranial arterial luminal stenosis indicating atherosclerotic lesions. In particular, left distal ICA and mid basilar artery stenosis appear to be more than 50% of luminal stenosis.4. No intracranial arterial aneurysm is seen.