Clinical question: Stroke. Signs and symptoms: Right hemiparesis. Nonenhanced brain MRI:Diffusion weighted images demonstrates demonstrate a small nonhemorrhagic acute lacunar infarct along the posterior limb of left internal capsule and measuring approximately 8 mm in size. Tiny punctate foci of apparent restricted diffusion are noted in the splenium of corpus callosum on the left. This finding is believed to be an artifactual finding as a result of a punctate focus of susceptibility at the site on SWI.Flair and T2 weighted images demonstrate mild chronic nonhemorrhagic small vessel ischemic strokes primarily in the periventricular and minimally in the subcortical white matter of cerebral hemispheres and pons. The anatomical morphology and the signal intensity of brain parenchyma is otherwise within normal on all MRI sequences.The signal void in the major intracranial arterial branches are identified. Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced brain MRA:Patent and unremarkable bilateral vertebral arteries and bilateral pica branches. Basilar artery remains widely patent. Patent bilateral superior cerebellar and posterior cerebral arteries. Mild irregularity of superior cerebellar artery branches suggestive of mild atherosclerotic disease.Patent bilateral internal carotid arteries across the skull base and in their supraclinoid segments. Patent bilateral anterior and middle cerebral arteries and their branches with minimal atherosclerotic irregularity of the vessel. Enhanced neck MRA:Examination is severely degraded due to extensive motion artifact which precludes precise assessment of vasculature.The visualized aortic arch is unremarkable.The origins of major vessels are widely patent.Brachial cephalic and bilateral subclavian arteries demonstrate mild atherosclerotic plaques without significant vascular lumen compromise. Right common carotid, internal carotid and external carotid arteries are unremarkable.Left common carotid, internal carotid and external carotid arteries are unremarkable. Bilateral vertebral arteries appear patent. The origins of vertebral arteries however cannot be properly assessed due to excessive motion artifact.
1.Pre-and post-enhanced brain MRI demonstrate an acute nonhemorrhagic lacunar infarct of the posterior limb of the left internal capsule measuring 8mm. Chronic small vessel ischemic strokes of mild to moderate degree and unremarkable exam otherwise.2.Nonenhanced brain MRA demonstrate patency of all intracranial vasculature. Very mild atherosclerotic irregularity of the vessel walls is however noted. 3.Enhanced neck CT is severely degraded due to extensive motion artifact. The origins of the vertebral arteries cannot be properly assessed. The vertebral arteries however beyond their origins appear patent bilaterally. No definitive vascular lumen compromise of bilateral common carotids, internal carotids or the external carotid arteries detected.