Reason: seizure focus vs new ischemic disease. please compare to previous History: confusion, dysarthria and generalized weakness. concern for seizure MRI of the brainNo diffusion weighted abnormalities are appreciated.Much of the imaging is degraded by patient motion.There is redemonstration of small foci of encephalomalacia in the right superior parietal lobule adjacent to the interparietal sulcus, right occipital pole and cerebellar hemispheres.Taking into account differences in imaging technique, there is no interval change.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 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. The left eyeball lens is thin. The right eye is elongated along the AP dimension and has a thin sclera.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left posterior communicating artery is relatively small but can be identified. The right posterior cerebral artery has fetal origin. The right p1 segment is very small. The vertebral arteries are similar in size.MRA neck:The great vessels from the aortic arch are not adequately evaluated. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The origins of the vertebral arteries are not adequately evaluated. There is no significant stenosis along the course of the vertebral arteries.
1.There is no evidence for acute ischemic cerebral infarction.2.The origins of the vertebral arteries and the origins of the great vessels from the aortic arch are not adequately evaluated. 3.There is redemonstration of small foci of encephalomalacia in the right superior parietal lobule, right occipital pole and cerebellar hemispheres.These are most likely ischemic in origin. Taking into account differences in imaging technique, there is no interval change compared to the prior exam from 3/14/12.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. There is no interval change compared to the prior exam from 3/14/12.5.Right eye staphyloma.6.No evidence for intracranial aneurysm.7.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.