 MRI BRAIN: The exam is mildly motion degraded limiting evaluation. There is an acute infarct involving the right frontal and parietal operculum, right insular cortex with additional small focus of infarction in the inferior frontal lobe with mild regional sulcal effacement and mass effect. Tiny focus of diffusion hyperintensity involving the paramedian left parietal lobe medially may be related to procedure. Susceptibility sequence is motion degraded, however no obvious hemorrhage is appreciated. There is an old infarct in the left occipital lobe, left cerebellar hemisphere, left posterior limb of the internal capsule, and the left corona radiata with encephalomalacia. There are moderate periventricular and subcortical nonspecific T2 signal abnormalities which likely represent moderate chronic microvascular ischemic changes. There is no hydrocephalus. There is no midline shift or herniation. A nasogastric tube is partly imaged.MRA BRAIN: The anterior and posterior circulation is intact without flow limiting stenosis or intracranial aneurysm. Both vertebral arteries join to form the basilar artery. Tiny bilateral posterior communicating arteries are present. The anterior communicating artery is not definitely visualized.MRA NECK: The proximal right vertebral artery is not well seen which may be artifactual or related to mild non-flow limiting stenosis. right. There is separate origin of the brachiocephalic, left common carotid and left subclavian arteries. The right vertebral artery is nondominant. Bilateral common carotid and internal carotid arteries are patent. There is no flow-limiting stenosis in the bilateral carotid bifurcations (less than 50% by NASCET criteria bilaterally).
1.Acute right MCA territory infarcts involving the right frontoparietal operculum, insula, right frontal coronal radiata and a small focus in the inferior right frontal lobe. No significant mass effect. Susceptibility sensitive sequence is motion degraded however no obvious hemorrhage is appreciated. Tiny focus of restricted diffusion involving the paramedian left parietal lobe medially may be related to procedure or represent an additional tiny focus of infarct. 2.Chronic infarcts in the left occipital lobe and the left cerebellar hemisphere as detailed above. Moderate chronic small vessel ischemic disease.3.No significant steno-occlusive lesions in the intracranial or extracranial circulation in the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.