76 years Male (DOB:11/8/1940)Reason: eval for ischemia History: R-sided weakness, aphasiaPROVIDER/ATTENDING NAME: DAVID HOWES MRI of the brainThere is diffusion restriction involving the majority of the left MCA territory. There is associated loss of signal in the perimedullary draining veins on SWI images. There is associated subtle FLAIR signal abnormality.There is redemonstration of encephalomalacia involving the right superior frontal gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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. The left eye lens is thin.There is motion artifact present.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 occlusion of the left MCA at the distal m1 segment with involvement of both inferior and superior divisions and sparing of a stenotic left rolandic branch. There is a stenosis at the junction of the left A1 and A2 segments.There is no evidence for intracranial aneurysm .The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.There is occlusion of the left MCA at the distal m1 segment with involvement of both inferior and superior divisions and sparing of a stenotic left rolandic branch. 2.There is a stenosis at the junction of the left A1 and A2 segments.3.There is a large left MCA territory infarction currently evolving.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for intracranial aneurysm.6.Unchanged encephalomalacia within the right superior frontal gyrus. This is most likely vascular related7.Findings were reviewed with the Dr Martinez.8.Patient motion artifact may obscure more subtle abnormalities.