Weakness [R53.1], Reason for Study: ^Reason: assess for stroke History: dizziness Brain MRIThere are restricted diffusion lesions on bilateral PICA territories indicating acute ischemic infarctions.There is no evidence of hemorrhagic conversion.Prior ischemic infarction related bilateral cerebellar PICA territorial encephalomalacia are seen.Patch bi-hemispheric FLAIR/T2 high signal intensities on periventricular white matter indicating nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.There is a retention cyst on the right maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate small right distal vertebral artery. However, bilateral ICAs, MCAs, ACAs, basilar artery and the distal left vertebral artery appear to be unremarkable.No significant intracranial arterial luminal stenosis.No intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate irregularities of the right vertebral artery which terminate at the origin of the right PICA. The PICA itself is visualized.Otherwise, bilateral CCAs and extra cranial ICAs appear to be normal without luminal stenosis.The left vertebral artery shows some irregularity of lumen without evidence of critical (more than 50%) stenosis.
1. Acute ischemic infarctions on bilateral PICA territories without hemorrhagic transformation.2. Chronic ischemic infarction related encephalomalacia.3. Non specific small vessel ischemic disease, unchanged.4. No evidence of significant (more than 50%) extracranial luminal stenosis. The right vertebro basilar junction is not seen but the right PICA is visualized on neck MRA. 