68 years Female (DOB:7/11/1948)Reason: evaluate for embolic stroke History: left face and arm weakness, slurred speech, left field cutPROVIDER/ATTENDING NAME: MICHAEL ANDREW WARD MRI of the brainThere is diffusion restriction present along the lateral aspect of the right precentral gyrus which extends to the right centrum semiovale. This measures approximately 33 x 11 mm axial dimensions.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.Images are degraded due to patient motion artifact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the left distal vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right vertebral artery is not identified. The may be some retrograde filling of the distal right vertebral artery.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. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The left common carotid artery originates from the innominate artery.The proximal common carotid arteries and the proximal vertebral arteries are not well imaged. The right vertebral artery is not readily identified.Images are degraded due to patient motion artifact.
1.Acute infarction involving the right postcentral gyrus and adjacent centrum semiovale.2.Occlusion of the right vertebral artery.3.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 4.The proximal common carotid arteries and the proximal vertebral arteries are not well imaged on this exam.5.Examination is somewhat compromised due to patient motion artifact.