Vision loss L>R, concern for giant cell arteritis. Brain MRI: There appears to be a punctate focus of cortical restricted diffusion in the right parietal lobe with high T2 signal. There are otherwise several scattered foci of high T2 signal in the cerebral hemisphere white matter bilaterally. There is no evidence of intracranial hemorrhage or mass. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Brain MRA: The anterior branch of the left superficial temporal artery and left ophthalmic artery appear relatively diminutive. There is no evidence of significant cerebral steno-occlusive lesions or aneurysms.Orbits MRI: There are bilateral lens implants. The lacrimal glands, optic nerve, orbital fat, and extraocular muscles otherwise appear unremarkable bilaterally. There is no evidence of intraorbital tumors.
1. Apparent punctate acute infarct in the cortex of the right parietal lobe superimposed upon a background of probable chronic small vessel ischemic white matter disease.2. The anterior branch of the left superficial temporal artery and left ophthalmic artery appear relatively diminutive, which may represent manifestations of giant cell temporal arteritis. Doppler ultrasound may be useful for further interrogation.