Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: Pt with history of CVA and residual right sided deficits, evaluate for possible worsening History: as above Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is slit like tissue defect on the left basal ganglia in particular putamen with susceptibility artifacts indicate chronic hemorrhagic infarction, no change since prior scan.Non specific small vessel ischemic changes on bilateral periventricular white matter, no change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree intracranial and extracranial arterial luminal stenosis were seen.In particular, the left MCA proximal M1 segment just beyond the the left ICA bifurcation shows more than 70% luminal stenosis. The right ICA cavernous sinus segment and the right MCA proximal M1 segment also show about 50% luminal narrowing.Comparing to prior scan, the left MCA M1 segment luminal narrowing appears to be slightly progressed but the right ICA cavernous sinus segment showed slightly improved since prior scan. Due to inherent technical issue, the degree of luminal stenosis progression of internal carotid artery cannot be reliably compared especially with TOF MRA technique. Therefore, if clinically indicated CTA should be considered. Bilateral extracranial ICA at the junction of cervical segment and carotid canal segment shows more than 50% luminal stenosis. Vertebrobasilar system appears to be slightly ectatic in luminal diameter and irregular lumen without evidence of luminal stenosis.
1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of chronic hemorrhagic infarction on the left basal ganglia and non specific small vessel disease since prior scan.3. More than 70% stenosis of the left MCA proximal M1 segment stenosis and about 50% stenosis of the right ICA cavernous sinus segment and bilateral extracranial ICA at the junction of cervical segment and carotid canal segment. CTA of head and neck can be considered for further evaluation if clinically indicated. 