Unspecified disturbances of skin sensation [R20.9], Reason for Study: ^Reason: evaluate for stroke History: R face, arm, leg Brain MRIThere is focal restricted diffusion on the left thalamus without evidence of susceptibility artifact indicating acute/subacute ischemic stroke without hemorrhagic conversion.Underlying brain shows scattered high signal intensity on T2/FLAIR images indicating nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. 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 4 x 3 mm sized right MCA distal M1 segment aneurysm.There is also about 2.8mm x 3.8mm sized left pcom arterial bulge which appears to be connected with a small patent left pcom artery. This lesion could represent infundibulum. However, the size and configuration are suggesting possibility of associated pcom aneurysm.Bilateral P-comm arteries are patent.Luminal irregularities without significant luminal stenosis are seen on intracranial arterial system indicating atherosclerotic changes.There is no other intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 5 mm sized aneurysmal bulge on the right ICA distal aspect of petrous segment.Left vertebral artery ostium arises very proximal to the left subclavian artery thus difficult to evaluate on this imaging due to artifact.Otherwise bilateral common carotid arteries, bilateral carotid bifurcation as well as right vertebral artery appears to be unremarkable.
1. Acute/subacute ischemic infarction on the left thalamus without evidence of hemorrhagic conversion.2. Right MCA distal M1 aneurysm and left Pcom possible aneurysm as described above. 3. Right distal petrous segment ICA aneurysm. 