62 years Female (DOB:2/5/1954)Reason: evaluate for left MCA vs. internal capsule stroke History: right weakness and difficulty understanding speechPROVIDER/ATTENDING NAME: GREGG M HELLAND GREGG M HELLAND MRI of the brainThere is a focus of diffusion restriction present along the left medial pons.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. 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 demonstrate mucosal thickening in the right sphenoid sinus. The visualized portions of the mastoid air cells demonstrate scattered opacities. The visualized portions of the orbits are intact.MRA brain:The right vertebral artery is very small distal to the origin of the right posterior inferior cerebellar artery. Left vertebral artery is also small and there is a 60% stenosis along the distal left vertebral artery. There is a approximately 66% stenosis of the basilar artery just above the level of the right anterior inferior cerebellar artery origin. There are bilateral fetal posterior cerebral artery artery origins. The P1 segments are hypoplastic.There is 70% stenosis at the origin of the inferior division of the left middle cerebral artery.There is 60% stenosis at the origin of the right anterior cerebral artery.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is very small. There is extracranial origin of the right posterior inferior cerebellar artery.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. There is no significant stenosis along the course of the vertebral arteries. The thyroid gland has a heterogeneous appearance
1.There is an acute lacunar infarct present along the medial aspect of the left half of the pons.2.There is 60% stenosis of the left vertebral artery near its junction to the basilar artery. 3.There is 70% stenosis along the mid basilar artery just above the level of the right anterior inferior cerebellar artery origin. There is fetal origin of the posterior cerebral arteries bilaterally associated with hypoplastic P1 segments4.There is 70% stenosis at the origin of the inferior division of the left middle cerebral artery.5.There is 60% stenosis at the origin of the right anterior cerebral artery.6.No evidence for extracranial cerebrovascular occlusive disease.7.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 