67 years Female (DOB:9/2/1948)Reason: new left sided hand weakness History: left handed weakness and tinglingPROVIDER/ATTENDING NAME: MICHAEL A WARD JAMES A MASTRIANNI MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additionally there are patchy T2 and FLAIR hyperintense lesions in the pons and the midbrain.There are punctate T2 and FLAIR hyperintense foci present in the left thalamus and left basal ganglia. These are not associated with diffusion restriction.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.On susceptibility imaging there are punctate foci of signal loss present in the left thalamus and left basal ganglia.The 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 vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There appears be a focal stenosis at the proximal the right middle cerebral artery M1 segment on the noncontrast MRA of the brain, however, on the MRA of the neck which is with contrast this is not apparent. As a result this apparent right M1 narrowing probably represents artifact. Along the distal posterior cerebral artery vasculature there are apparent foci of narrowing and dilation. The basilar artery appears somewhat irregular but not stenotic. The carotid siphon is also irregular but not stenotic on both sides. There appears to be narrowing of the right internal carotid artery at the distal cavernous segment with approximately 40% stenosis.There is asymmetry in the size of the A1 segments of the left A1 segment being larger than the right A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. The left vertebral artery smaller than the right vertebral artery . 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. The left vertebral artery smaller than the right vertebral artery and the proximal left vertebral artery is stenotic.
1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree as well as some patchy lesions in the pons and midbrain are nonspecific. At this age they are most likely vascular related. 3.Punctate lesions in the left thalamus and left basal ganglia may be related to prior lacunar infarcts.4.There is no intracranial cerebrovascular occlusion or stenosis appreciated. Some intracranial vasculature is irregular suggesting atherosclerosis.5.There is no evidence for extracranial cerebrovascular occlusion or stenosis.6.There are couple microhemorrhages present in the left thalamus and left basal ganglia. In isolation these are somewhat nonspecific. They could be hypertensive in nature given the locations.