 MRI Brain:There is no diffusion abnormality. No intracranial mass or mass effect. There are mild-moderate periventricular and subcortical punctate white matter FLAIR hyperintensities. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.The eyeball lenses are thin.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. There is occlusion of the left A1 segment as well as focal narrowing of the distal left M1 segment with attenuation of the superior division of the left MCA. There is a relatively small anterior communicating artery which is supplying the left A2 segment and beyond. The right middle and right anterior cerebral arteries are patent. The right V4 segment is small. The left vertebral artery, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is not readily identified.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is approximately 20% stenosis of the proximal right ICA and approximately 25-30% stenosis of the left proximal ICA by NASCET criteria. There is occlusion of the right vertebral artery from its origin to the mid V2 region where the vertebral artery reconstitutes via collaterals. There is also a high-grade stenosis at the origin of the left vertebral artery.
1.Occlusion of the left A1 segment with the left A2 segment being supplied by a relatively small anterior communicating artery.2.Focus of narrowing at the distal left M1 segment at the inferior division with additional attenuation of the superior division of the left MCA.3.Occlusion of the right vertebral artery at its origin with collateral reconstitution at the mid V2 region and occlusion of the intracranial right vertebral artery.4.High-grade stenosis of the origin of the left vertebral artery.5.Approximately 20% stenosis of the proximal right ICA and approximately 25-30% stenosis of the left proximal ICA by NASCET criteria.6.There is no evidence for acute cerebral ischemic infarction.7.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 