Diagnosis: Weakness WeaknessClinical question: strokeSigns and Symptoms: l weakness MRI of the brainA small focus of diffusion restriction is present in the right pons.Punctate foci of T2 hyperintensity with FLAIR and T1 hypointensity are present in the pons and right cerebellum. There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense lesions are also present in the pons and thalami.A punctate focus of signal loss on SWI is identified in the right upper pons while others identified in the left cerebral peduncle, several in each thalamus, basal ganglia, cerebellar hemispheres, deep structures of the cerebellum, left centrum semiovale and to a lesser degree subcortical white matter of the right temporal lobe, right frontal lobe and bilateral parietal lobes.The CSF spaces are appropriate for the patient's stated age with no midline shift. The visualized portions of the paranasal sinuses demonstrate some mile mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. 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 are foci of narrowing along the intracranial vertebral arteries.There is a high grade stenosis of the proximal basilar artery. There is fetal origin of the posterior cerebral arteries bilaterally with very small p1 segments.Loss of signal from the left m1 segment suggests stenosis.The anterior communicating artery is identified. The left A1 segment is small.
1.Acute lacunar infarction involving the right paramedian pons.2.There is vertebrobasilar cerebrovascular disease with high grade stenosis of the proximal basilar artery. Please note that there are bilateral PCA fetal origins.3.Left m1 segment MCA stenosis4.Multiple microhemorrhages in a pattern suggestive of hypertension.5.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 6.Brainstem and thalamic lesions are nonspecific. At this age they are most likely vascular related. 7.Old lacunar infarcts are suspected in the pons and right inferior cerebellumI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.