65 years Male (DOB:10/28/1950)Reason: status epilepticus History: first seizure in patient with known vasculopathy, HTN and multiple lacunar infarctsPROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG AGNIESZKA ANNA ARDELT MRI of the brainA punctate focus of diffusion restriction is present in the left frontal lobe .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are small foci of T2 and FLAIR signal hyperintensity present in the thalami, basal ganglia and the brainstem.There are multiple punctate foci of signal loss on susceptibility weighted imaging present in the thalami, basal ganglia and brainstem and cerebellar hemispheres.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not readily identified on this exam.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is small. The posterior communicating arteries are very small. MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The left vertebral artery is occluded proximally and reconstituted through collaterals distally.The right vertebral artery has a 60% stenosis at its origin
1.Occlusion of the left vertebral artery. 2.60% stenosis at the origin of the right vertebral artery.3.Acute microinfarct in the left frontal lobe 4.Old lacunar infarcts in the basal ganglia, thalami and brainstem5.There is a mild to moderate degree of microhemorrhages in the deep gray nuclei and posterior fossa structures was pattern is suggestive of hypertensive microhemorrhages.6.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 