Diagnosis: Cerebral infarction, unspecifiedClinical question: assess for stenosisSigns and Symptoms: right sided weakness, speech changes MRI of the brainThere is a punctate focus of diffusion restriction present in the left pons.There is a punctate focus of susceptibility effect with low signal on susceptibility weighted imaging in the right pons.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 demonstrate some mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate that the right mastoid air cells are partially opacified. The visualized portions of the orbits are intact.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 left A1 segment is larger than the right A1 segment. There is fetal origin of the right posterior communicating artery with the medium sized right P1 segment. The left posterior communicating artery is small. The vertebral arteries are similar in diameter.
1.There is an acute lacunar infarct in the left pons.2.There is an old microhemorrhage in the right pons. 3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.