68 years Male (DOB:11/24/1947)Reason: eval for vessel occlusion History: right hemiparesisPROVIDER/ATTENDING NAME: NAVNEET CHEEMA CHRISTOPHER M GOMEZ MRI of the brainThere is a focus of diffusion restriction present along the posterior limb of the left internal capsule.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a moderate degree of confluent periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate T2 and FLAIR hyperintense foci are present in the basal ganglia, thalami and brainstem.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 scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is some marrow replacement along the odontoid tip.MRA brain:There is a 5 mm fusiform aneurysm present along the basilar artery at the origin of the left anterior inferior cerebellar artery which encompasses the left anterior inferior cerebellar artery origin.There is a posterior left laterally directed 4 mm wide neck aneurysm present at the basilar artery between the levels of the anterior inferior cerebellar artery and the superior cerebellar artery.There is a 2 mm infundibulum present at the origin of the right posterior communicating arteryAntegrade 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 and is small in diameter. The posterior communicating arteries are not well visualized. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is 80% stenosis stenosis along the proximal third of the cervical segment of the left vertebral artery
1.Acute lacunar infarct along the posterior limb of the left internal capsule. 2.There are 2 aneurysms present along the basilar artery. One is 5 mm and fusiform and at the level of the left anterior-inferior cerebellar artery were it incorporates the origin of the left anterior inferior cerebellar artery. The other is wide necked and between the levels of the superior cerebellar artery and anterior inferior cerebellar artery measuring 4 mm diameter. In addition there is a 2 mm infundibulum at the origin of the right posterior communicating artery.3.There is an 80% stenosis along the course of the left vertebral artery.4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Multiple punctate lesions in the basal ganglia, thalami and brainstem are likely related to prior vascular events.6.There appears to be marrow replacement along the odontoid tip. It is not clear based on this exam whether it represents sclerosis or an infiltrating lesion. A CT of the cervical spine may be of benefit to further evaluate this.7.At the time of dictation an alphanumeric page was sent to Dr. Fintel.