Reason: 85 yo F h/o with prior head CT from UIC which revealed a "shadow" in her brain that she decided to call "tumor," presenting with new onset R arm and leg paresthesias MRI of the brain: Left middle frontal gyrus hypoattenuation seen on prior CT is without diffusion restriction and increased T2/FLAIR signal compatible with chronic ischemic injury. Left occipital lobe and splenium of the corpus callosum with T2/FLAIR hyperintensity also compatible with chronic ischemic injury. There are additional scattered subcortical and periventricular white matter T2/FLAIR hyperintensities compatible with chronic small vessel ischemic disease.No acute intracranial hemorrhage. No mass, mass effect, or midline shift. Scattered foci of susceptibility artifact compatible with mineral deposition or microhemorrhages. No abnormal enhancement.MRA of the brain: Normal contrast opacification is present throughout the anterior and posterior circulation. Bilateral fetal PCAs with prominent right posterior communicating artery are noted. No significant narrowing, aneurysm, or dissection of the vasculatures. Superficial and deep intracranial venous drainage is unremarkable.MRA of the neck: Conventional anatomy of the aortic arch. Probable critical stenosis at the origin of the left vertebral artery. Tortuosity and incomplete band like signal intensity at the proximal right subclavian artery which cause about 50% of luminal stenosis. This could represent atherosclerotic luminal stenosis but could also simply reflect tortuosity of the artery. Common carotid arteries are patent. There is irregularity of the left distal common carotid artery and carotid bulb without significant stenosis.
1.Chronic ischemic changes involving left frontal lobe, left occipital lobe and left side corpus callosum splenium.2. Underlying non specific small vessel ischemic disease.3. Probable critical stenosis of the left vertebral artery origin. CT angiogram may be pursued for further imaging evaluation if clinically indicated.4. Tortuosity and possible approximately 50% stenosis of the right proximal subclavian artery as described above. 