Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke work up History: as above56 years Male (DOB:7/14/1960)Reason: stroke workup History: dysarthria, aphasia, rUE weaknessPROVIDER/ATTENDING NAME: JAMES A. MASTRIANNI Brain MRIThe left insular cortex shows restricted diffusion lesions which extends toward left side corona radiata. There is no no evidence of hemorrhagic conversion.Scattered several T1/FLAIR high signal intensity lesions on periventricular white matter and centrum semiovale are non specific but could represent 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. 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 about 1.3mm sized luminal bulge on the posterior right side of the top of the basilar artery which directs posteriorly. This lesion is likely represent a small aneurysm. Regarding anterior circulation, bilateral ICAs, MCAs and ACAs are normal. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Acute ischemic infarction involving left insular cortex and corona radiata without evidence of hemorrhagic conversion.2. Possible small aneurysm (about 1.3mm) posterior aspect of the top of basilar artery. CT angiography can be considered for further imaging evaluation if clinically indicated. Otherwise unremarkable brain MRA.3. Normal neck MRA. 