83 years Female (DOB:10/3/1932)Reason: weakness in BLE, dizziness - w post circ? New stroke? PROVIDER/ATTENDING NAME: DANIEL P. SULMASY DANIEL P. SULMASY MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Patchy T2 and FLAIR hyperintense lesions are present within the brainstem. Multiple T2 hyperintense punctate foci are present within the basal ganglia and thalami which are not associated with substantial FLAIR abnormality.There are several punctate foci of signal loss and susceptibility imaging within the thalami bilaterally.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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. There is mild narrowing of the distal right internal carotid artery at the distal cavernous segment and proximal ophthalmic segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. The left vertebral artery is small and the proximal portion left vertebral artery is not completely identified.
1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease. Please note the proximal left vertebral artery is not adequately imaged.3.Periventricular and subcortical white matter lesions of a moderate degree and patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 4.Microhemorrhages predominantly in the thalami are suspected to be related to hypertension. Please correlate with clinical history