Right PCA territorial stroke based on CT scan. There is right occipital lobe, and right posterior inferior thalami restricted diffusion lesions indicating acute ischemic infarctions on the right PCA territory. There is no evidence of hemorrhagic transformation.There are focal encephalomalacia on bilateral inferior parietal lobules (left side lesion is larger than that of right side) indicating chronic ischemic lesion.There focal high signal intensity lesions on bilateral frontal lobes on FLAIR images which imply chronic lacune infarctions.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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate subtle irregularities of intracranial arteries. Especially the right MCA M1 segment shows about 30% of luminal stenosis. Other arteries demonstrated luminal irregularities but no evidence of luminal stenosis more than 30%. Vertebrobasilar system also shows luminal irregularities but no luminal stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate significant artifacts especially on arterial phase on bilateral common carotid artery region. Bilateral common carotid arteries were visualized on venous phase without showing any evidence of luminal stenosis.The vertebral artery origins do not show any evidence of luminal stenosis although demonstrated irregularities.
1. Acute ischemic infarctions on the right PCA territory without evidence of hemorrhagic transformation.2. Multifocal various degreed luminal irregularities on both intracranial and extracranial arterial system indicating atherosclerotic changes. However, there is no significant (more than 50%) luminal stenosis on arterial system.