 MRI: There is a linear focus of restricted diffusion implant hyperintensity in the left hemipons medially consistent with acute infarct. There is other mild nonspecific periventricular and subcortical T2 signal abnormality. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, and in the right frontal operculum. These may represent foci of chronic microhemorrhage.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is fluid in the nasal cavity with mild frontal, moderate ethmoid and right sphenoid sinus mucosal thickening. Sagittal T1 weighted images are not available.MRA: Mild motion artifact degrades axial image quality. Within this limitation, no focal high-grade stenosis is identified in the intracranial circulation. There is a 4 x 4 mm saccular aneurysm arising at the branch point of the right M1 segment directed laterally, which may actually originate from the proximal right M2 segment. The neck of the aneurysm is not well visualized. The right vertebral artery is slightly larger compared to the left, with development to diminutive left V4 segment post-PICA. There is moderate narrowing of the distal left V4 segment. Both vertebral arteries join to form the basilar artery.
1.Acute medial left hemipontine nonhemorrhagic infarct. Other nonspecific foci of white matter FLAIR hyperintensity likely which likely represents chronic small vessel ischemic changes.2.No flow limiting intracranial stenosis, with moderate narrowing of the distal left V4 segment.3.4 x 4 mm saccular aneurysm arising from the right M1 segment branching point, likely originating from the proximal inferior M2 segment. CTA of the head recommended for further evaluation, as the neck is not well visualized on this MR exam.Findings were communicated with the emergency department by the radiology resident on call at the time of preliminary interpretation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.