 MRI BRAIN:There is restricted diffusion in the right posterior medulla with associated increased T2 signal compatible with an acute infarct (601/23). Additional scattered T2 hyperintensities without restricted diffusion in the periventricular and subcortical white matter are nonspecific but likely related to mild chronic small vessel ischemic disease.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits. MRA BRAIN:There is moderate narrowing of the cavernous internal carotid arteries bilaterally. There is moderate stenosis of the right M1 segment. The left MCA appears normal. The ACAs are normal without stenosis or aneurysm. There is a right PCOM artery, although no left PCOM artery is identified.There is poor flow-induced signal in the V4 segment of the right vertebral artery, especially at the vertebrobasilar junction. The basilar artery itself is narrow, which may be congenital. The PICA's are identified bilaterally and appear normal.
1.Focus of diffusion restriction in the right medulla is compatible with an acute infarct.2.Poor flow related signal within the distal right vertebral artery is suspicious for significant stenosis or occlusion. 3.Moderate stenoses affecting the cavernous ICAs and the right M1 MCA.Findings discussed with Dr. Ali at 11:45 a.m. on 1/20/2015