Diagnosis: Headache(784.0)Unspecified transient cerebral ischemiaClinical question: 57 yo lady with blurry vision and ataxia, evaluate for potential TIASigns and Symptoms: lightheadedness, blurry vision, ataxia MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. 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 bilateral fetal origin of the PCA with small p1 segments bilaterally.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. There is no significant stenosis along the course of the left vertebral artery. The proximal right vertebral artery appears significantly narrowed, however, artifact partially obscures this area. A CTA of the chest from 4/21/2010 did not demonstrate any significant stenosis at the proximal RVA.
1.The proximal right vertebral artery appears significantly narrowed, however, it is possible that this appearance is related to artifact. A CTA may be able to better evaluate this vessel. A CTA of the chest from 4/21/2010 did not demonstrate any significant stenosis at the proximal RVA.2.There is no evidence for acute ischemic cerebral infarction.3.There is no evidence for intracranial aneurysm or intracranial cerebrovascular occlusive disease.