Clinical question: Evaluate for stenosis. Signs and symptoms: Left-sided weakness. Nonenhanced brain MRI:Diffusion weighted series demonstrate a focus of cortical restriction involving the precentral gyrus of the right frontal lobe consistent with an acute ischemic stroke. This finding is well visualized on FLAIR and T2-weighted images. Finding is nonhemorrhagic and produces very subtle mass effect.Additional examination demonstrate multiple small cortical strokes involving bilateral frontal lobes, bilateral posterior parietal-occipital lobes as well as bilateral posterior temporal lobes. There is ex vacuo dilatation of supratentorial ventricular system with maintained midline. Images through posterior fossa also demonstrate few small chronic cerebellar strokes.Nonenhanced brain MRA:Right internal carotid artery is patent across the skull base in its supraclinoid segment. Mild atherosclerotic smooth narrowing of the supraclinoid carotid caliber is detected. The right anterior and middle cerebral arteries are identified and unremarkable in their proximal portions. Distal arterial atherosclerotic disease of branches of the right anterior and middle cerebral arteries are noted. A prominent right posterior communicating artery is identified.Left internal carotid artery is patent across the skull base and indicate supraclinoid segment. Left anterior and middle cerebral arteries are unremarkable in their proximal segments. The distal branches however demonstrate atherosclerotic disease with multiple foci of moderate to severe stenosis. Bilateral vertebral arteries and basilar artery are widely patent. Superior cerebellar and bilateral posterior cerebral arteries are identified.Enhanced neck MRA:The visualized aortic arch and the origins of major vessels are all unremarkable. Brachiocephalic branching and bilateral subclavian arteries are widely patent. Bilateral common carotid arteries, internal carotid arteries and external carotid arteries and including the origins are unremarkable.
1.Nonenhanced brain MRI demonstrate a focus of restricted diffusion without evidence of hemorrhage in the right frontal precentral gyrus. Extensive chronic ischemic strokes of bilateral cerebral hemispheres and bilateral cerebellar as detailed.2.Nonenhanced MRA of intracranial circulation demonstrate patency of all major intracranial vasculature. Atherosclerotic disease with regions of moderate to severe stenosis of the distal branches of anterior and middle cerebral arteries are identified.3.Enhanced neck MRA is unremarkable as detailed above.