66 years Male (DOB:5/5/1950)Reason: Stroke work up History: R side sensory deficitPROVIDER/ATTENDING NAME: KATIE TATARIS KOUROSH A REZANIA MRI of the brainThere is a small focus of diffusion restriction present along the inferior and posterior lateral aspect of the left thalamus. This associated with vague T2 and FLAIR signal hyperintensityThere are punctate foci of T2 and FLAIR signal hyperintensity located in the basal ganglia, thalami and brainstem.There is a mild to moderate 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 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 clear. The visualized portions of the orbits are intact.MRA brain:There is 90% stenosis at the origin of the right posterior cerebral artery.There is 50% stenosis of the right pericallosal artery at the proximal A4 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 small. The posterior communicating arteries are very very small.. The right vertebral artery is smaller than the left vertebral artery.There is extracranial and extradural origin of the right posterior inferior cerebellar 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 left vertebral artery. There is a 75% stenosis at the origin of the right vertebral artery.The right vertebral artery is smaller than the left vertebral artery.
1.Findings are compatible with acute lacunar infarct located in left thalamus.2.There is a 75% stenosis at the origin of the right vertebral artery.3.There is 90% stenosis at the origin of the right posterior cerebral artery4.Punctate lesions in the basal ganglia, thalami and brainstem are most likely related to prior lacunar infarcts5.Periventricular and subcortical white matter lesions of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 