69 years Male (DOB:11/19/1946)Reason: encephalopathy History: encephalopatyPROVIDER/ATTENDING NAME: BRYAN A CAMPBELL SANDEEP S PULIMI 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.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal 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 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 are clear. The visualized portions of the mastoid air cells are partially opacified. 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 is loss of signal present at the petrous segments of internal carotid arteries which is suspected to be artifactual. There are mild foci of narrowing without significant stenosis at the cavernous segments of the internal carotid arteries. There is loss of signal present at the proximal intracranial right vertebral artery just distal to the extracranial origin of the right posterior inferior cerebellar artery.There is mild narrowing of the left M1 segment with approximately 50% stenosis.At the proximal right M1 segment there is a 1.5 mm saccular extension protruding superiorly. No perforators are identified cessation this.The right A1 segment is hypoplastic.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are medium-sized. There is an infundibulum at the origin of the posterior communicating artery bilaterally.. The vertebral arteries are similar in size.
1.There is some intracranial cerebrovascular narrowings present without significant stenosis on the basis of WASID criteria. There is 50% narrowing at the left M1 segment.2.At the proximal right M1 segment there is a 1.5 mm saccular extension suspected to represent an aneurysm. It could also represent an infundibulum of the perforators not visualized on this exam. If clinically appropriate a CT angiogram may be helpful here.3.There is signal loss along the petrous segments of the internal carotid arteries as well as the right vertebral artery. As a result evaluation of these specific locations is suboptimal on this exam.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.There is no evidence for acute ischemic cerebral infarction on this exam.