Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: eval for L BG stroke and brainstem/cerebellar atrophy History: b/l chorea, athetosis, and dementia Brain MRIMotion artifacts degraded exam quality.No evidence of acute ischemic or hemorrhagic lesion on the scan.There are susceptibility artifacts on the right basal ganglia extended toward right side midbrain and the right cerebellar hemisphere indicating hemosiderin deposition due to prior hemorrhagic lesion.Patchy FLAIR high signal intensities on bilateral periventricular white matter as well as centrum semiovale indicate nonspecific small vessel ischemic disease.Multifocal tissue losses involving bilateral basal ganglia, right external capsule bilateral periventricular white matter and right cerebellar hemisphere suggest prior mixed hemorrhagic and ischemic stroke.There is no evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree intracranial arterial luminal narrowings including right distal vertebral artery, basilar artery, and bilateral MCAs indicating intracranial atherosclerotic changes. The degree of stenosis on especially non contrast enhanced MRA is not accurate and most likely exaggerated but the distal right vertebral artery and right MCA proximal M2 segment appear to be about or slightly higher than 50%.The left distal vertebral artery is not seen which could be related to hypoplastic in nature or occlusion.There is no evidence of intracranial arterial aneurysm.
1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Hemosiderin depositions on the right basal ganglia and right cerebellar hemispheric lesion indicating prior (chronic) hemorrhagic infarction.3. Multifocal tissue losses indicate chronic ischemic infarctions.4. Non specific small vessel ischemic disease.5. Multifocal intracranial arterial luminal narrowings suggest intracranial atherosclerotic changes. 