Diagnosis: Unspecified transient cerebral ischemia.Clinical question: recurrent left leg weakness event, rule out intracranial stenosisSigns and Symptoms: recurrent left leg weakness. MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several punctate T2 hyperintense lesions in each cerebellar hemisphere.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.There is metal artifact originating from the medial aspect of the left eyelid which on a recent CT of the head represents a metallic foreign body on the skin surface.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. There is medial deviation of the left lamina papyracea compatible old medial blowout.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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are again defined. The left posterior communicating artery is medium-sized wires the right posterior communicating artery is small. Anterior communicating artery is small.. The right vertebral artery is larger than the left vertebral artery. The left vertebral artery is hypoplastic distally.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for intracranial mass lesion4.Punctate lesions in the cerebellar hemispheres are most likely vascular related