62 years Female (DOB:2/12/1954)Reason: Evaluate for infarct History: Woke up with bilateral leg weaknessPROVIDER/ATTENDING NAME: JAMES J WALTER ADIL J JAVED MRI of the brainNo diffusion weighted abnormalities are appreciated.There is some encephalomalacia involving the right centrum semiovale where there is ex vacuo effect along the right lateral ventricle.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate T2 and FLAIR hyperintense lesions are present in the brainstem.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 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 internal carotid artery flow voids are absent.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:The internal carotid arteries are not identified in either side proximal to the communicating segment on the left and proximal to the communicating segment on the right. The ophthalmic arteries are not readily identified. The right posterior communicating artery is not readily identified.. There appears to be greater time of flight signal within the left middle cerebral artery versus the right middle cerebral artery. The left posterior communicating artery is fairly large.Is not clear whether the left anterior cerebral arteries occluded or the A2 segment is azygos. There is a tubular type of extrusion coming off of the right proximal A2 segments which could represent a blood vessel or an aneurysm. It measures approximately 4 mm in length and 1.5 mm in diameter. It is directed laterally and has a curved course. The anterior communicating artery is small to medium sized.Antegrade flow is present in the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right vertebral artery is larger than the left vertebral artery.
1.Findings suggest occlusion of the internal carotid arteries proximal to the communicating segments. Supply to the anterior circulation is predominantly via the left posterior communicating artery. It appears that the anterior communicating artery offers some resistance to flow in the right middle cerebral artery.2.It is not clear whether the left A2 segment is occluded or whether there is an azygos A2 segment. If clinically appropriate a CT angiogram be helpful to further investigate.3.There is a tubular extrusion of the right A2 segment near the anterior communicating artery junction with the right A2 segment which could either represent an aneurysm or a vessel. Perhaps a CT angiogram would help further evaluate this.4.There is encephalomalacia along the right centrum semiovale which is suspected to represent a watershed distribution infarction.5.Periventricular and subcortical white matter lesions as well as lesions in the brainstem of a mild degree are nonspecific. At this age they are most likely vascular related. 