Procedure: MRA NECK WWODiagnosis: Slurred speech Other specified disorders of muscleClinical question: eval vesselsSigns and Symptoms: stroke code w/u MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of a small focus of encephalomalacia along the pons an area measuring 12 x 8 mm axial dimensions associated with volume loss in the pons which is eccentric to the left side. There is associated T2 and flair signal hyperintensity in the left medulla and left cerebral peduncle.There are dilated perivascular spaces present throughout the cerebral white matter.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 minor opacities in the maxillary sinuses, right sphenoid sinus and left frontal sinus. 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 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 small to medium size. The posterior communicating arteries are intact and small. The vertebral arteries are similar in size.The left PICA has extracranial origin.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 LCCA originates from the innominate artery.
1.There is redemonstration of an old small infarct involving the left pons which is associated with volume loss and some Wallerian degeneration2.there is no evidence for extracranial or intracranial cerebrovascular occlusive disease.3.There is no evidence for acute cerebral infarction