Reason: r/o stenosis History: hx of R ICA stenosis, left sided weakness MRI of the brainThere are approximately 10 punctate foci of diffusion restriction present in the medial aspect of the right frontal and parietal lobe and the right inferior parietal lobule. These are new since the prior exam. Prior foci of diffusion restriction in the watershed zone of the right hemisphere do not display diffusion restriction on today's exam. On T2 and FLAIR MRI sequences, there is redemonstration of hyperintense lesions in the right hemispheric watershed as well as small foci of hyperintensity in the basal ganglia, cerebellum and brain stem.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are punctate foci of signal loss on susceptibility imaging in the thalami, brainstem, left cerebellar hemisphere and basal ganglia.The right ICA flow void is absent. Normal vascular flow voids are present in the distal left 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.MRA brain:The right internal carotid artery is occluded along the cavernous and opthalmic segments but reconstituted along the communicating segment via the PCOMA. This was also present on prior exams.Antegrade flow is present in the distal left internal carotid artery, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.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.Exam is degraded my motion artifact which may obscure subtle abnormalities.
1.The right internal carotid artery is occluded along the cavernous and opthalmic segments but reconstituted along the communicating segment via the left PCOMA. This was also present on prior exams.2.There are approximately 10 punctate foci acute infarction present in the medial aspect of the right frontal and parietal lobe and the right inferior parietal lobule. These are new since the prior exam and additive to prior watershed distribution punctate infarcts.3.Small lesions in the brainstem and basal ganglia most likely represent prior lacunar infarcts.4.Multiple micro-hemorrhages are present in the thalami, basal ganglia, brainstem and cerebellum suggesting a distribution suggestive of hypertension. 5.Periventricular and subcortical white matter changes of a mild degree are nonspecific but most likely vascular related.