Muscle weakness (generalized) [M62.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: eval for stroke History: right sided weakness Brain MRIMotion artifact degraded image quality.There is focal restricted diffusion at the left frontal lobe precentral gyrus indicating acute ischemic infarction without evidence of hemorrhagic conversion.Encephalomalacia with volume loss were seen on bilateral occipital lobes indicating chronic ischemic infarcts. On gradient echo imaging, there are multifocal skeletal susceptibility lesions involving bilateral occipital lobes and parietal lobes on the left with encephalomalacia indicating chronic petechial hemorrhagic lesions.Multifocal chronic small lacunar infarctions on bilateral basal ganglia. Patchy T2/flair high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. 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 MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no evidence of significant (more than 50%) luminal narrowing on bilateral ICAs, MCAs and ACAs. There is no evidence of intracranial arterial aneurysm. Vertebrobasilar system appears to be normal. Neck MRANoncontrast enhanced neck MR angiogram demonstrates forward flow through bilateral cervical segment of internal carotid arteries and vertebral arteries. However, due to significant motion artifacts and the low signal to noise ratio, precise evaluation for bilateral common carotid arteries, bilateral carotid bifurcations, and bilateral vertebral artery ostia are not possible. In fact, the Neck MRA is non-diagnostic.
1. Acute ischemic infarction without evidence of hemorrhagic transformation involving left frontal lobe precentral gyrus.2. Chronic ischemic infarction with chronic petechial hemorrhages involving bilateral occipital and parietal lobes.3. Non specific small vessel ischemic disease. Multiple lacunar infarctions on bilateral basal ganglia.4. No evidence of significant intracranial arterial luminal stenosis. No intracranial arterial aneurysm.5. Non diagnostic Neck MRA.