65-year-old female with a transient receptive aphasia. LE hemisphere TIA vs stroke. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered small foci of periventricular and subcortical white matter T2/flair hyperintensities which are nonspecific but are likely related to small vessel ischemic disease. There is evidence of a multiple small chronic left cerebellar infarcts. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: There is scattered atherosclerotic disease involving the intracranial arteries, probably including the laceral portion of the left internal carotid artery, left greater than right cavernous ICA segments, and M2/M3 segments of the left MCA although the quality of the exam is suboptimal for full assessment. The left A1 segment is mildly hypoplastic but the anterior cerebral arteries are otherwise patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: The exam is limited by motion, especially in the upper chest region. There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is probably moderate atherosclerotic narrowing of the proximal left common carotid artery. The common carotid arteries and cervical internal carotid arteries are otherwise normal in course and caliber. Analysis of the proximal vertebral arteries limited secondary to motion but the origin of the vertebral arteries otherwise appear grossly patent.
1.No evidence of acute intracranial hemorrhage or infarct.2.Scattered likely chronic small vessel ischemic disease.3.Diffuse scattered atherosclerotic disease in the neck and brain as described above but no high-grade or occlusive stenosis.