Diagnosis: Syncope and collapseClinical question: stenosisSigns and Symptoms: syncope MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate T2 and FLAIR hyperintense lesion is present in the right cerebellar hemisphere measuring approximately 7 mm in diameter. This could represent an old lacunar infarct.There are multiple punctate subcortical foci of susceptibility effect identified on susceptibility imaging. As a punctate focus of susceptibility present within the midbrain. Several foci of susceptibility effect are present in the cerebellar hemispheres.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 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. There is fetal origin of the right posterior cerebral artery. The left posterior communicating artery is small. The right A1 segment is smaller than the left A1 segment. The pericallosal arteries are asymmetric in diameter. The left pericallosal artery is larger than the right pericallosal artery. The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery. The right vertebral artery is smaller than the left 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. There is no significant stenosis along the course of the vertebral arteries.
1.There is no evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 3.There is a mild degree of microhemorrhages distributed in predominantly subcortical white matter and also brainstem and cerebellum which do not have a specific pattern of distribution.4.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.5.Findings are compatible with old lacunar infarct in the right cerebellar hemisphere.