73 years Female (DOB:2/13/1943)Reason: Evaluate for steno-occlusive disease or etiology of stroke History: aphasia, R sided neglectPROVIDER/ATTENDING NAME: WILLARD W SHARP Brain MRIMultifocal scattered restricted diffusion lesions are seen on the left middle frontal gyrus, precentral gyrus, post central gyrus and inferior parietal lobule indicating acute ischemic infarctions. There is no evidence of hemorrhagic conversion.Multiple FLAIR/T2 high signal intensity lesions seen mainly on periventricular white matter and centrum semiovale likely represent non specific small vessel ischemic disease.There are also susceptibility lesions without associated with surrounding edema on the left temporal lobe, left posterior insular, right thalamus, bilateral cerebellar hemispheres suggest possible chronic petechial hemorrhages or parenchymal mineralizations. The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifacts significantly reduces image quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. No evidence of intracranial arterial luminal narrowing or irregularity. No arterial aneurysm is seen.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuosities of extracranial bilateral ICAs without evidence of significant luminal stenosis. The left proximal ICA just above the bifurcation shows less than 50% of luminal stenosis.Aortic arch and major arch vessels appear to be patent without evidence of luminal stenosis.The vertebral artery origins are normal.
1. Scattered acute ischemic infarctions on the left frontal and parietal lobes in particular, middle frontal gyrus, pre and post central gyrus and inferior parietal lobule without evidence of hemorrhagic conversion.2. No evidence of acute hemorrhagic lesions.3. Non specific small vessel ischemic disease. Multifocal chronic petechial hemorrhages or mineralizations.4. Significant motion artifacts degraded image quality for brain MRA. However, no definitive evidence of intracranial major arterial luminal narrowing is seen. No evidence of intracranial aneurysm.5. Tortuous course of extracranial arterial system indicating atherosclerosis without evidence of significant (more than 50%) of luminal stenosis.If clinical indicated, more precise craniofacial arterial system can be considered with head and neck CTA. 