56 years Female (DOB:8/13/1959)Reason: Eval posterior stroke History: dizzinessPROVIDER/ATTENDING NAME: ROBERT A MULLIKEN JEANNE M DECARA MRI of the brainSeveral punctate foci of diffusion restriction are identified. One is located in the right periventricular white matter. One is located in the left centrum semiovale. One is located in the left occipital lobe.There are 4 or 5 periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images..Is a punctate focus of signal loss and susceptibility imaging in the left half of the splenium of the corpus callosum. Initial location this is of unknown clinical significance.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 left vertebral artery, 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 small. The posterior communicating arteries are there are small. The right vertebral artery is not readily identified. The right posterior inferior cerebellar artery territory and appears to be supplied via the right anterior inferior cerebellar artery. There is extracranial origin of the left posterior inferior cerebellar artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. The right vertebral artery is small and ends just proximal to the level of the foramen magnum. The anterior spinal artery years to be supplied from the left vertebral artery. 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 are several acute microinfarcts identified in the periventricular and subcortical white matter in the multiple cerebral territories.2.Occlusion of the right vertebral artery distally. Radiology is not established on this exam.3.Anterior spinal artery is prominent but otherwise unremarkable. It is possible this represents a collateral supply to right vertebral artery territory to the brainstem.