Acute cerebrovascular accident. Redemonstration of multifocal supra and infratentorial bihemispheric acute ischemic infarctions without evidence of hemorrhagic transformation. No change since prior scan.Extensive nonspecific small vessel ischemic disease and left cerebellar encephalomalacia seen do not show any interval change either.Multifocal susceptibility artifacts are again seen, no change since prior exam.Although there are significant motion artifacts for post contrast scans which degraded diagnostic accuracy, there is no definitive evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. 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 multifocal various degree narrowing of intracranial vessels especially on bilateral M2 and 3 of middle cerebral artery as well as bilateral P2 and PCA segments of posterior cerebral arteries.However, these lesions are nonspecific since the resolution of MR angiogram is limited. In addition, these findings are difficult to differentiate from atherosclerotic changes from intracranial vasculitis. To clarify the nature of intracranial arterial narrowing, diagnostic catheter angiogram is highly recommended if clinically indicated.There is no intracranial aneurysm on this MR angiogram. 3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate slightly ectatic and tortuous but maintaining 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. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. No interval change of multifocal ischemic infarctions without hemorrhagic transformation since prior scan.2. No definitive evidence of abnormal enhancement.3. Multifocal various degreed intracranial arterial luminal irregularities and narrowings especially medium sized vessels as described above. These findings are non specific especially based on MR angiography. Differential diagnosis include atherosclerotic changes or intracranial vasculitis. If clinically suspicious for intracranial vasculitis as described on clinical history section, a diagnostic catheter angiography is highly recommended for the clarification and differential diagnosis.4. Some atherosclerotic changes of cervico-carotid arterial system without evidence of significant luminal stenosis.