Altered mental status. Clinical suspicion of stroke. The study is at least moderately limited by patient motion.Brain MRI:There is no diffusion restriction to indicate an acute/recent stroke. Bifrontal and central pontine white matter T2 hyperintensity may reflect chronic ischemia. The bifrontal abnormality may also reflect gliosis from a previous injury. There is questionable susceptibility effect within this region on the very limited ventricles sequence. The CSF-containing spaces are mildly enlarged which reflects mild volume loss. There is no mass effect or midline shift. Orbits are notable for previous right cataract surgery and left sided calcifications with FLAIR hyperintensity involving the posterior aspect of the left lobe which may be related to chronic retinal detachment. The paranasal sinuses show minimal, if any, mucosal thickening but no fluid.Cranial MR angiography:While the petrous segments of the internal carotid arteries show preserved caliber and flow-related signal, the cavernous and clinoid/supraclinoid segments are narrowed and irregular. While this may partly relate to motion artifact, atherosclerosis can also give a similar appearance. Left A1 is diminutive which may be related to hypoplasia. There is fairly symmetric and preserved flow-related signal and caliber of the more distal branches of the middle and anterior cerebral arteries on both sides. The basilar artery is predominantly supplied by the left vertebral artery. The posterior cerebral arteries show preserved flow-related signal with the left one predominantly supplied through a large posterior communicating artery (fetal origin).Cervical MR angiography:The cervical MR angiogram is even more degraded by motion and vessel morphology/caliber cannot be accurately assessed. Both common and internal carotid arteries show flow-related signal that is fairly symmetric. The right vertebral artery is small at its cervical and intracranial segments. This can be congenital but chronic ostial narrowing can also similar.
1.Study is at least moderately limited by motion.2.There is no evidence of acute infarct. Pontine T2 signal abnormality may be related to chronic small vessel ischemic disease. Larger area of T2/FLAIR hyperintensity in the bilateral inferior frontal lobes without mass effect is nonspecific but favored to represent gliosis related to prior infarct, trauma, or other injury. No associated mass effect to suggest vasogenic edema. Suggest comparison with outside prior studies or possibly follow-up MRI examination with sedation if there is continued suspicion for an acute process.3.Mild to moderate narrowing of the cavernous and clinoid/supraclinoid segments of the internal carotid arteries with dense atherosclerotic calcifications evident on CT. Left A1 is small which may be related to hypoplasia. Otherwise no high-grade stenosis is evident in the intracranial circulation.4.Cervical MRA is severely limited by motion though shows grossly patent vessels. The small size of the right vertebral artery can be congenital as described above.5.Findings suggestive of retinal detachment on the left with moderate-sized effusion in the posterior aspect of the left globe; suggest correlation with history and examination.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.