Reason: r/o acute stroke History: r sided sensory deficits MRI of the brainThere is a punctate focus of diffusion restriction present along the right thalamus.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional FLAIR and T2 hyperintense punctate lesions are present along the basal ganglia and brainstem.There are numerous punctate foci of susceptibility along the posterior fossa structures and basal gangila with much lesser involvement of the subcortical white matter.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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 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 demonstrate air fluid level in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sella.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. The posterior communicating arteries are intact. The vertebral arteries are similar in size.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 LCCA originates from the innominate artery.The vertebral artery origins are tortuous. There is 40% narrowing at the origin of th right vertebral artery. There is no significant stenosis along the course of the vertebral arteries.
1.There is a punctate focus of acute infarction along the left superior thalamus.2.Innumerable microhemorrhages are present in a pattern suggestive of hypertension.3.Older lacunar infarcts are present in the basal ganglia, brainstem and thalamus.4.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for intracranial cerebrovascular arterial stenosis6.No evidence for significant extracranial cerebrovascular occlusive disease. There is 40% narrowing at the origin of the right vertebral artery.