Reason: Stroked w/u History: R face and arm weakness MRI brain: There are patchy foci of diffusion restriction along the left basal ganglia with corresponding decrease in ADC signal. There is subcortical and periventricular nonspecific white matter T2 hyperintensities, which may represent chronic small vessel ischemic disease. Chronic appearing infarcts of the right basal ganglia and left cerebellar cortex. There is generalized volume loss with prominence perivascular space, ventricles, and sulci.No acute intracranial hemorrhage is identified. No evidence of intracranial mass or midline shift. No extra-axial fluid collections. Nonspecific mucosal thickening of the ethmoid air cells. Mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable. MRA brain: There is normal flow voids of the circle of Willis vessels. The distal left vertebral artery is small in caliber and appears nonpatent proximal to the V4 segment. No evidence of aneurysm or dissection. MRA neck: Conventional anatomy of the great vessels. Left common carotid shows mild narrowing at the level of the thyroid gland. Otherwise bilateral carotid arteries are patent. Left vertebral artery is occluded at the origin with no opacification until V3/V4 junction where very small artery is evident. Normal opacification of the right vertebral artery. No evidence of aneurysm or dissection.
1.Acute ischemia of the left basal ganglia.2.Occlusion of the left vertebral artery beginning at the origin and extending to the V3/V4 junction. 3.The intracranial vessels are free of significant stenosis.4.Findings discussed with Dr. Xiao pager 4174 on 2/27/16 at 9:13AM. 