Reason: evaluate for ischemia History: slurred speech, L facial weakness MRI of the brainthere is diffusion restriction present in the subcortical white matter and centrum semiovale of the right frontal lobe with a punctate lesion in the right insular cortex. There is associated adjacent signal loss on SWI in the adjacent peri-medullary veins.Several punctate foci of signal loss are present in the subcortical white matter of the left frontal lobe. These are nonspecific in isolation.There is a focal signal loss on the T1 weighted higher signal on T2 present in the lower pons with a lesion measuring approximately 3 mm in diameter. It is associated with a more profound signal loss on susceptibility imagingThere is a mild to moderate 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 abnormal 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 demonstrates scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 right middle cerebral artery as 3 and divisions in this patient. The largest one which supplies the posterior parietal artery, angular artery and of the central and precentral arteries is occluded at the proximal M2 segment.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. There is a fetal origin of the posterior cerebral arteries bilaterally with a small P1 segments The vertebral arteries are similar in size.
1.There is a branch occlusion of the right middle cerebral artery at the proximal M2 segment.2.There is acute/subacute infarction present in the right frontal lobe mainly involving white matter corresponding to the middle cerebral artery branch occlusion.3.There is a small hemorrhagic lesion present in the pons. It is nonspecific. One possibility is that this represents a cerebral cavernous malformation, however, it may also represent residua from a small old hemorrhage.4.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 