Reason: evaluate for ischemia History: altered mental status and known old CVA MRI brain:There is atrophy of the cerebellum and brainstem. Within the pons there is a rounded lesion with peripheral punctate foci of susceptibility measuring approximately 8 mm in diameter which is best seen on the CT scan where it is a hyperdense lesion.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The anterior communicating artery is identified. The posterior communicating arteries are small. The vertebral arteries are asymmetric - right larger than left.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.
1.There is cerebellar and brainstem atrophy present. One possibility is that this represents a spinocerebellar atrophy.2.There is a lesion present within the pons associated with some calcifications (better identified on CT). It does not appear to represent a cerebral cavernous malformation. Perhaps a post contrast CT would be helpful.