51 years Male (DOB:7/31/1964)Reason: assess for stenosis History: left face and arm weaknessPROVIDER/ATTENDING NAME: KEME H CARTER RICHARD KRAIG MRI of the brainThere is a small focus of diffusion restriction present along the posterior limb of the right internal capsule.There is a mild to moderate degree of periventricular and subcortical white matter signal hyperintensities on T2 and FLAIR MRI imaging. Additionally there are T2 and FLAIR hyperintense lesions present in the right internal capsule, basal ganglia and external capsules as well as the brainstem.On susceptibility imaging there are punctate foci of signal hypointensity present in the basal ganglia and thalami as well as the lower brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. There is a stenosis present along the left posterior cerebral artery along the left perimesencephalic cistern at the posterior aspect of the left P2 segment.The anterior communicating artery appears to be fenestrated. The posterior communicating arteries are not readily identified. The left vertebral artery is larger than the right vertebral artery.There is some mild degree dilatation of imaging due to some patient motion.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The right vertebral artery is smaller than the left vertebral artery
1.There is an acute lacunar infarct present along the right internal capsule at the posterior limb.2.There is a stenosis present along the left P2 segment.3.There are microhemorrhages present within the basal ganglia and brainstem which are in a pattern suggestive of hypertension.4.There are punctate lesions present in the basal ganglia and brainstem which probably represent old infarcts.5.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 6.Please note that the aneurysms less than 3 mm in size may be overlooked in exam like this with mild motion artifact.