83 years Female (DOB:2/11/1933)Reason: stroke work up History: as abovePROVIDER/ATTENDING NAME: TERESITA M. HOGAN MRI of the brainNo diffusion weighted abnormalities are appreciated. Incidental note is made of partial empty sella.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 demonstrate some scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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. Incidental note is made of azygos A2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The posterior communicating arteries are very small and intact. 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 are weblike defects present along the distal internal carotid arteries. The distal internal carotid arteries are highly tortuous.There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery significantly larger than the right vertebral artery. There are weblike defect present along the distal left vertebral artery.
1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a minor degree are nonspecific. At this age they are most likely vascular related. 3.Weblike defects along the internal carotid arteries and left vertebral artery are present. It is possible that these are related to fibromuscular dysplasia.4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.