72 years Male (DOB:9/7/1944)Reason: ro stroke History: vertigoPROVIDER/ATTENDING NAME: NAOUM ISSA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. A couple punctate lesions are also present in the brainstem which are hyperintense on T2 and FLAIR MRI.Punctate focus of loss of signal on susceptibility weighted imaging is present in the right occipital lobe subcortical white matter. In isolation this is nonspecific and likely of little clinical significance..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: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 A1 segment is hypoplastic The left posterior communicating artery is very small. There is fetal origin of the right posterior cerebral artery. The right P1 segment is small to medium sized. The left vertebral artery is larger than the right vertebral 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. The origins of the vertebral arteries appear to be narrowed bilaterally with findings suggestive of stenosis of the left vertebral artery at its origin as well as the right vertebral artery at its origin.
1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is no evidence for acute ischemic cerebral infarction.3.Findings suggest stenosis at the origins of the vertebral arteries bilaterally.4.Several periventricular and subcortical white matter lesions as well as a couple lesions in the brainstem are present which are nonspecific nonspecific. At this age they are most likely vascular related. 