right side weakness, right visual disturbance, evaluate for ischemia or evidence of tumor, history of CEA left in 2014 There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Scattered bihemispheric patchy high signal intensities on FLAIR images indicate non specific small vessel ischemic disease.Encephalomalacia on the left occipital lobe indicate chronic ischemic infarction. 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, restricted diffusion/acute ischemia, or abnormal contrast enhancement. 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the right internal carotid artery. The right ICA is reconstituted through the patent right Pcom artery and Acom artery. The left ICA, bilateral MCAs and bilateral ACAs appear to be normal. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate complete occlusion of the right ICA just above the bifurcation. The left distal CCA appears to be significantly narrowed (about 90%) with evidence of endarterectomy. The right vertebral artery is dominant and shows about more than 50% of luminal stenosis at its ostium.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Complete occlusion of the right ICA just above the bifurcation. Intracranial right ICA is reconstituted via right Pcom and Acom artery.3. Post endarterectomy status of the left extracranial carotid system with evidence of more than 90% stenosis on the distal left CCA.4. More than 50% luminal stenosis, left vertebral artery ostium.5. Non specific small vessel ischemic disease with chronic ischemic infarction on the left PCA territory. 