 Brain MRI:Restricted diffusion with ADC hypointensity and T2 hyperintensity is present involving right basal ganglia crossing the anterior limb of the internal capsule as well as separate foci within the right frontal, right temporooccipital, and temporal lobes. There is no susceptibility abnormality or significant enhancement.There is an unchanged arachnoid cyst overlying the left anterior temporal lobe, inferior left frontal lobe, and insula, with mass effect upon the underlying brain parenchyma. There are mild scattered foci of cerebral white matter T2 hyperintensity and a small area of encephalomalacia in the left basal ganglia. There is also small cortical gliosis involving the left post central gyrus from remote infarct, unchanged. Redemonstrated is lack of the normal flow void in the left internal carotid artery, unchanged.The cerebellar tonsils are in normal position. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is lack of flow in the distal left internal carotid artery involving its petrous and cavernous sinus portions, as demonstrated previously by MRI. Flow is noted involving the left MCA, presumably secondary to flow across a visualized anterior communicating artery as the left posterior communicating artery is nonvisualized. There is a tiny right visualized posterior communicating artery. There is a small area of focal stenosis involving the right MCA M1 segment, with patent flow noted in distal MCA segments. There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery. Neck MRA:There is irregular plaque with possible ulceration at the origin of the right internal carotid artery without hemodynamically significant stenosis.There is complete occlusion of the left internal carotid artery from its origin.There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant, although the left vertebral artery origin is previously visualized as it primarily lies outside the slab of acquisition.
1.Acute right MCA territory distribution infarct.2.Unchanged left arachnoid cyst.3.Stable chronic vascular disease.4.Irregular plaque with possible ulceration at the origin of the right internal carotid artery without hemodynamically significant stenosis.5.Complete occlusion of the left internal carotid artery from its origin.6.Results were discussed with Dr. Palai on 10/3/2016 at 10:10 AM