Slurred speech [R47.81], Reason for Study: ^Reason: POST TPA, L M1/M2 OCCLUSION - PLEASE INCLUDE PERFUSION History: right arm weakness Brain MRIThere is restricted diffusion on the left external capsule without evidence of hemorrhagic transformation.Scattered somewhat patchy T2/flair high signal intensity lesions on periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease.Several lacunar infarcts involving bilateral basal ganglia and thalami are seen.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 90% occlusion of the left MCA distal M1 segment.Hypoplastic left distal vertebral artery with a possible long segment stenosis.There are luminal irregularities with various degree stenosis of intracranial arteries including right MCA M2 segment, basilar artery and bilateral PCAs indicating atherosclerotic changes.There is no evidence of intracranial arterial aneurysm.
1. Acute ischemic infarction involving the left external capsule without evidence of hemorrhagic transformation.2. More than 90% stenosis of the left MCA M1 segment.3. Multifocal various degree intracranial arterial luminal irregularities and stenosis indicating intracranial atherosclerosis. 