58 years Female (DOB:1/25/1958)Reason: rule out stroke History: right sided clumsiness, weaknessPROVIDER/ATTENDING NAME: IRA J BLUMEN HELENE G. RUBEIZ MRI of the brainThere is a small focus of diffusion restriction present in the posterior limb of the left internal capsule which extends to the centrum semiovale.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:There appears to be duplication of the right middle cerebral artery. Findings suggest a 2 mm aneurysm at the community in segment of the right internal carotid artery. Findings also suggest a 2 mm aneurysm at the distal left internal carotid artery at the communicating segment.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.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 left posterior communicating artery. The right posterior communicating artery is small. The vertebral arteries are similar in size. The vertebrobasilar system is tortuous.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 vertebral arteries.
1.Acute Lacunar infarction in the posterior limb of left internal capsule.2.The distal right internal carotid artery appears to be ectatic and associated with a duplicated right middle cerebral artery. 3.Findings suggest a small bilateral aneurysms at the at the distal internal carotid arteries distal to the origins of the posterior communicating arteries. This can be confirmed by CT angiography if clinically appropriate.4.The intracranial vasculature is tortuous which is a nonspecific finding.