53 years Female (DOB:3/19/1963)Reason: eval for acute stroke History: left facial droop, dysarthria, ?productive aphasiaPROVIDER/ATTENDING NAME: DAVID G BEISER CATHERINE A BONHAM MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia involving the left superior parietal lobule extending towards the left inferior parietal lobule.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 demonstrate some mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is somewhat degraded due to motion artifact on many of the pulse sequences.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 fetal origin of the posterior cerebral arteries bilaterally with a hypoplastic left P1 segment and a small right P1 segment.Basal artery appears narrowed proximally. The distal vertebral arteries also appear narrowed.There is focal narrowing of the right middle cerebral artery with approximately 50% stenosis.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.There is encephalomalacia present along the left parietal lobe.2.Findings raise the question of the basilar artery stenosis as well as distal vertebral artery stenosis.3.50% stenosis at the proximal right middle cerebral artery is suspected.4.This could be an appearance produced by local artifacts. If clinically appropriate CT angiogram may help further assess this.5.Examination is somewhat degraded due to patient motion during the exam which would obscure more subtle abnormalities.