Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: right facial weakness History: right facial weakness Brain MRIMultiple scattered restricted diffusion on the left frontal lobe pre central gyrus and superoanterior aspect of the left external capsule without evidence of susceptibility artifacts indicating acute/subacute ischemic infarctions.Underlying brain shows patchy bihemispheric high signal intensities on T2/FLAIR images indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. 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 more than 50% luminal stenosis at the proximal basilar artery just below bilateral AICA origin. In additional there are multiple (at least 2 foci) tandem luminal narrowings on the right MCA M1 segment which appear to be less than 50% luminal stenosis. There is no intracranial arterial aneurysm. There is no evidence of additional intracranial arterial luminal stenosis. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate ectatic changes indicating atherosclerotic change. Aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries were tortuous but no evidence of luminal stenosis. The vertebral artery origins are normal. There is no evidence of luminal stenosis on the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Multifocal right frontal acute ischemic infarctions without evidence of hemorrhagic transformation as described above.2. Multiple tandem luminal stenosis (less than 50%) on the left MCA M1 segment.3. More than 50% luminal stenosis, proximal basilar artery just below the level of bilateral AICA origins.4. Atherosclerotic changes of extracranial craniocervical arterial system without evidence of significant luminal stenosis. 