Evaluate acute stroke and assess for early hemorrhagic conversion; right gaze deviation, left hemianopsia. Brain MRI:Motion artifacts degraded exam quality.There are multifocal restricted diffusion areas on the right frontal lobe, parietal lobe, temporal lobe and occipital lobe indicating acute ischemic infarction. There is no evidence of hemorrhagic transformation.Underlying brain show multiple scattered high signal intensities on periventricular white matter indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased in-flow signal intensity on the right MCA comparing to that of the left MCA indicating slow or decreased flow through the right MCA. Bilateral PCAs are fetal origin.Multiple tandem luminal narrowing (less than 50%) of vertebrobasilar system.Left MCA and bilateral ACAs appear to be normal.Neck MRA:3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 6mm segmental luminal stenosis of the right extracranial ICA just above the bifurcation, based on the MRA it appears to be about 90% stenosis. Right vertebral artery is dominant and the left vertebral artery is not clearly visualized with tortuosity indicating proximal left vertebral artery stenosis.The distal right vertebral artery appears to be irregular and there are multifocal luminal stenosis. Normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries.
1. Right MCA territorial (right PCA is fetal origin) acute ischemic infarction without evidence of hemorrhagic transformation.2. More than 90% luminal stenosis of the right ICA just above the bifurcation.3. Decreased in flow related enhancement on the right MCA than that of the left MCA indicating decreased or slower flow. 4. Atherosclerotic changes of the vertebrobasilar system indicating intracranial atherosclerosis. 