Reason: stroke History: slurred speech12/29/194372 yearsMale MRI of the brainThere are foci of encephalomalacia present in the right centrum semiovale and right basal ganglia. There is associated slitlike susceptibility effect in the right basal ganglia.On susceptibility imaging there is some decreased signal along the right hemispheric cortical vein vasculature.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. The right internal carotid artery is very small. There is diminished signal in the right middle cerebral artery vasculature.There is mild narrowing at the mid basilar artery with approximately 50% stenosis on the basis of WASID criteria.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 65% stenosis at the proximal left internal carotid artery. There is a high-grade stenosis (>90%) at the proximal right internal carotid artery associated with a diminutive right internal carotid artery cervical segment. There is no significant stenosis along the course of the vertebral arteries. The left common carotid artery originates from the innominate artery. The right ophthalmic artery appears larger than the left ophthalmic artery.
1.High-grade stenosis at the origin of the right internal carotid artery associated with string sign. Please note on the prior CTA from 2/15/2014 it appeared that the right internal carotid artery at that time was occluded. There is collateralization to the right anterior and middle cerebral arteries via the circle of Willis and the right ophthalmic artery. There is diminished blood flow to the right middle cerebral artery relative to the left middle cerebral artery indirectly suggested based on the MRA and susceptibility imaging.2.67% stenosis at the origin of the left internal carotid artery3.No evidence for acute ischemic cerebral infarction.4.Findings are compatible with encephalomalacia in the right centrum semiovale probably in part related to ischemia. This is new since the 2/16/2014 MRI exam but was present on the 3/22/2014 CT exam.5.Findings are suggestive of prior hemorrhagic infarction in the right basal ganglia. This is new since the 2/16/2014 MRI exam.