Slurred speech. Brain MRI: The examination is motion degraded. There is no evidence of acute infarct or hemorrhage. There is mild diffuse nonspecific T2 hyperintensity in the periventricular and subcortical white matter. There is also encephalomalacia in the left middle frontal gyrus and multiple defects in the bilateral inferior cerebellar hemispheres. There is no evidence of mass lesions or midline shift. The ventricles and sulci are unchanged in size and configuration, with mild diffuse cerebral volume loss. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: There is no evidence of significant steno-occlusive lesions or saccular aneurysms without the limits of MRA. There is a right fetal posterior cerebral artery, which is an anatomic variant.Neck MRA: The origin of the right vertebral artery is not well depicted and there appears to be significant stenosis of the brachiocephalic artery origin. There is also mild narrowing of the right common carotid artery just proximal to the bifurcation. The other major cervical arteries appear to be patent. There appears to be a 6 mm outpouching along the dorsal aspect of the aortic arch adjacent to the brachiocephalic artery origin.
1. Chronic small vessel ischemic disease and infarcts in the left middle frontal gyrus and inferior cerebellar hemispheres, but no evidence of acute intracranial hemorrhage, mass, or acute infarcts.2. The origin of the right vertebral artery is not well depicted and there appears to be significant stenosis of the brachiocephalic artery origin. 3. Apparent 6 mm outpouching along the dorsal aspect of the aortic arch adjacent to the brachiocephalic artery origin, which may represent a pseudoaneurysm or ulcerative plaque. A CTA may be useful for further evaluation.4. No significant steno-occlusive lesions intracranially.Discussed with Dr. at 11:40 AM on Maryam Mohammed.