53 years Female (DOB:1/15/1963)Reason: Evaluate for ischemia History: L facial droop, L arm and leg weaknessPROVIDER/ATTENDING NAME: MICHAEL A WARD SHASHA J WU MRI of the brainThere are patchy foci of diffusion restriction present in the right middle cerebral artery territory scattered in the right parietal lobe, right frontal lobe right basal ganglia, insular cortex and temporal lobe. Relative volume percentage of the territory is approximately 10%.There is encephalomalacia involving the right inferior parietal lobule. There are subcortical white matter T2 and FLAIR signal hyperintense foci adjacent to the superior frontal gyri bilaterally. There are punctate foci of T2 and FLAIR signal hyperintensity in the basal ganglia and thalami. There are smaller and fewer ill-defined foci of T2 to and FLAIR signal hyperintensity in the brainstem and right cerebellar hemisphere.There is a 4 mm T2 hyperintense focus with surrounding T2 hypointensity and T1 hyperintensity centrally as well as susceptibility effect located in the left basal ganglia.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. 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.Some imaging is degraded due to patient motion which will obscure more subtle abnormalities. On sagittal imaging appears to be some narrowing of the cervical spinal canal which is not adequately imaged on this exam.MRA brain:There is occlusion of the right middle cerebral artery at its origin. The right vertebral artery is smaller than the left vertebral artery.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, left middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.There is occlusion of the right middle cerebral artery at its origin.2.There are patchy foci of the diffusion restriction scattered in the right middle cerebral artery territory3.There is a 4 mm subacute hemorrhage is suspected in the left basal ganglia.4.A focus of encephalomalacia in the right parietal lobe is most likely a result of prior infarction.5.There are subcortical, periventricular, basal ganglia, thalamic and to a lesser degree brainstem and cerebellar lesions present which are likely vascular related.6.Some imaging is degraded due to patient motion which will obscure more subtle abnormalities.