Left-sided weakness There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal patch periventricular white matter lesions on FLAIR imaging indicating mild to moderate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate irregularity of right proximal extracranial internal carotid artery about 1 cm above the bifurcation. The degree of stenosis of the right extracranial proximal internal carotid artery is about 50%.The left extracranial internal carotid artery at the level of carotid bulb also shows about 30% luminal stenosis.Normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Mild to moderate nonspecific small vessel ischemic disease.3. Normal intracranial MR angiogram. 4. About 50% of luminal stenosis and irregularity on the right extracranial internal carotid artery just above the bifurcation and 30 % luminal stenosis on the left extracranial internal carotid artery at the level of the carotid bulb. Precise evaluation of luminal stenosis with and NASCET criteria can be performed with CT angiogram of head and neck.