Diagnosis: Unspecified cerebral artery occlusion with cerebral infarctionClinical question: Eval strokeSigns and Symptoms: Dysarthria MRI of the brainThere is a focus of diffusion restriction involving the left precentral gyrus lateral to the hand motor area. There is associated T2 and FLAIR signal hyperintensity.A small focus of diffusion restriction is present in the periventricular white matter adjacent to the trigone of the right lateral ventricle and the right posterior cerebral artery territory. There is associated T2 and FLAIR signal hyperintensity.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are 5-10 punctate subcortical foci of signal loss on susceptibility imaging in the right frontal lobe, right parietal lobe, right temporal lobe, left occipital lobe and left cerebellar hemisphere.Focus of volume loss associated with T2 and FLAIR signal hyperintensity measuring approximately 18 mm diameter and located within the anterior aspect of the left middle frontal gyrus.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and right 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 left vertebral artery flow-void is absentThe visualized portions of the paranasal sinuses are clear. 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 right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The left vertebral artery is not readily identified.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally with the small P1 segments. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. The left vertebral artery origin is not identified. The left vertebral artery is not small in the cervical portion, however, it is not identified at V3..The thyroid gland is markedly enlarged and associated with shift of the trachea towards the left side.
1.Left precentral gyrus focus of acute or subacute infarction located lateral to the hand motor area.2.Right periventricular white matter microinfarct in the acute or subacute stage.3.Findings are suspicious for left vertebral artery occlusion.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.There is a mild degree of subcortical microhemorrhages present in mainly in the supratentorial brain which is non-specific. Amyloid angiopathy is one possible explanation.6.A small focus of encephalomalacia is present in the left middle frontal gyrus which is most likely related to prior infarction.7.Thyromegaly.