Diagnosis: Cerebral infarction, unspecifiedClinical question: stroke?Signs and Symptoms: left sided weakness MRI of the brainThere is a small (9x7mm) focus of restricted diffusion with associated increased T2 and FLAIR signal within the right pons likely representing a small acute to subacute ischemic infarction. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Subcentimeter foci of T2/FLAIR signal hyperintensity are also present in the basal ganglia and right thalamus. The lesions in the basal ganglia are associated with susceptibility effect. The right basal ganglia lesion is also associated with 3mm size T1 hyperintensity. The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.Exam is mildly degraded by patient motion.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.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are medium size. The right vertebral artery is larger than the left vertebral artery.There is 70% stenosis at the proximal right p2 segment by WASID criteria.There is 80% stenosis at the distal left m1 segment by WASID criteria.There is 70% stenosis at the left vertebral artery intracranially distal to the PICA origin. The left PICA has extracranial originMRA 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. The LCCA originates from the innominate artery. There is 70% stenosis at the left vertebral artery intracranially distal to the PICA origin. The left PICA has extracranial origin
1.Right pontine acute infarction2.Older lacunar infarcts in the basal ganglia and thalami with mineralization along the right basal ganglia.3.There is 70% stenosis at the proximal right p2 segment.4.There is 80% stenosis at the distal left m1 segment.5.There is 70% stenosis at the left vertebral artery intracranially distal to the PICA origin. 6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.