39 years Male (DOB:8/21/1976)Reason: new onset seizure, subacute and chronic stroke History: new onset seizure, psychosis patent foramen ovale. hypohomocysteinemiaPROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS MRI of the brainThere is subacute focus of diffusion restriction involving the right inferior parietal lobule measuring approximately 46 x 64 mm in axial dimensions. This is associated with gyral enhancementThere is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Punctate foci of T2 and FLAIR signal hyperintensity are present in the right thalamus and right brain stem.There is a T2 and FLAIR hyperintense lesion involving the corpus callosum and adjacent cingulate gyrus at the anterior aspect of the body of the corpus callosum with an junction to the genu. It measures 11 x 14 mm sagittal dimensions.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a mucous retention cyst in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. The right angular artery appears to be occluded along the mid M2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.Subacute infarction involving the right parietal lobe in the territory of the right angular artery.2.Findings are compatible with occlusion of the right angular artery3.Old lacunar infarcts involving the right brain stem and right thalamus and corpus callosum.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. They are unusual for the patient's stated age but given the other findings they are most likely vascular related.5.Findings were discussed with Dr. Fintel at the time of this dictation