Reason: Eval for TIA/stroke like symptoms History: transient paresthesias, dyscoordination, numbness MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a small T2 and flair signal hyperintensity present along the right pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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 mild mucosal thickening in the ethmoid air cells. 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 and the proximal anterior, middle and posterior cerebral arteries.The right vertebral artery demonstrates normal antegrade flow beyond the origin of the right posterior inferior cerebellar artery. The left vertebral artery is diminutive distally. The basilar artery appears to be occluded or near occluded beginning at the vertebrobasilar junction. The posterior communicating arteries appear to be the main supply to the posterior cerebral arteries and the P1 segments.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.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. The left common artery originates from the innominate artery. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is mild narrowing of the proximal right internal carotid artery with approximately 20% focal narrowing approximately 15 mm from the origin of the right internal carotid artery. There is no significant stenosis along the course of the vertebral arteries.
1.Findings are compatible with occlusion or near occlusion of the distal right vertebral artery intracranially as well as the basilar artery with reconstitution of posterior circulation flow via collaterals from the anterior circulation as well as the posterior inferior cerebellar arteries.2.There is no evidence for acute ischemic infarction appreciated.3.Findings suggest an old lacunar infarct in the right pons