 MRI brain:There are areas of diffusion restriction compatible with acute infarcts involving the following regions: bilateral frontal corona radiata, right frontal lobe cortex in the middle and inferior frontal gyri extending to the operculum, right insular cortex, left caudate body, left putamen, superior aspect of the left thalamus and right inferior medial cerebellar hemisphere. There is corresponding hyperintense T2/FLAIR signal abnormality.Mild global cerebral volume loss. Partially empty sella is noted. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. Bilateral lens implants.MRA brain:The intracranial internal carotid arteries are normal in course and caliber. There is abrupt termination of a branch of the distal right M2 segment with associated susceptibility artifact indicating thrombus. The left middle and bilateral anterior cerebral arteries are unremarkable. A small right posterior communicating artery is identified. The left posterior communicating artery is not well seen. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence aneurysm.MRA neck:Images are technically degraded due to motion artifact, as per technologist note, patient was moving during MRA neck portion despite attempting restraint.There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are grossly patent.The left vertebral artery origin is patent. Proximal right vertebral artery is not well seen, which may reflect artifact and/or high-grade stenosis. The left vertebral artery is dominant. There is no evidence of occlusion of the remainder of the cervical vertebral arteries.
1.Multiple acute infarcts in the bilateral cerebral hemispheres and right cerebellum, as described above. 2.Occlusion of a branch of the distal right M2 segment with suggestion of thrombus. Major intracranial vasculature is otherwise patent.3.MRA neck images are significantly motion-degraded. Right vertebral artery origin not well seen, likely in part due to artifact though high-grade stenosis cannot be excluded. Major neck vasculature is otherwise grossly patent. If further detailed evaluation is desired, repeat MRI or CTA may be considered.Findings communicated via telephone with Dr. Loggini at 9:22 AM on 8/26/2016.