Cerebral infarction, unspecified [I63.9] / Hemiplegia, unspecified affecting unspecified side [G81.90] / Diplopia [H53.2], Reason for Study: ^Reason: Hx of metastatic melanoma s/p premlozumab treatment with right hemiparesis, diplopia , R/o PRES, brain me Brain MRI:There are multiple restricted diffusion lesions involving left side lower midbrain-upper pons posterior aspect, left middle cerebellar peduncle and left superior cerebellar hemisphere indicating acute ischemic infarction without evidence of hemorrhagic transformation. There are also focal lacunar infarcts on the left basal ganglia posterior aspect and the right parietal lobe. Underlying brain shows multifocal patchy high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel disease.No evidence of metastasis.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate the left superior cerebellar artery is not visualized. This could be related to hypoplastic left SCA, however, could also represent focal occlusion. Bilateral distal ICAs, right distal vertebral artery, left PCA P2-P3 junction appear to be narrowed in luminal diameter indicating intracranial atherosclerosis.There is no evidence of intracranial arterial aneurysm. Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous but normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Acute ischemic infarct involving left lower midbrain, upper pons, left middle cerebellar peduncle and part of left superior cerebellar hemisphere without evidence of hemorrhage transformation.2. Multiple lacunar infarcts with the nonspecific small vessel ischemic disease on underlying brain.3. Nonvisualization of left superior cerebellar artery. Underlying intracranial arterial system shows atherosclerotic changes. No intracranial aneurysm was seen. 4. No evidence of significant luminal stenosis on extracranial arterial system.