Muscle weakness (generalized) [728.87], Reason for Study: ^Reason: please look for occlusion in right sided weakness There are multiple restricted diffusion lesions on the left thalami and left basal ganglia including left external and internal capsule without evidence of hemorrhagic conversion indicating acute ischemic infarction.Underlying brain shows multifocal patchy high signal intensities on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal luminal narrowings including bilateral MCAs and proximal to mid basilar artery showing about more than 50% of luminal stenosis indicating intracranial atherosclerosis.No intracranial aneurysm was seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate minimal to moderate (about 30%) luminal narrowings on the right proximal extracranial ICA just above the carotid bifurcations. Right vertebral artery is hypoplastic. The left vertebral artery shows multifocal narrowings on the cervico-cranial junction to the level of vertebrobasilar junction area.
1. Acute ischemic infarction on the left thalami and basal ganglia without evidence of hemorrhagic conversion. 2. Underlying non specific small vessel ischemic disease.3. MR evidence of intracranial atherosclerosis.4. About 30% luminal stenosis of the right extracranial ICA as described above. The right vertebral artery is hypoplastic.