Unspecified atrioventricular block [I44.30] / Other speech disturbances [R47.89] / Atrioventricular block, complete [I44.2], Reason for Study: ^Reason: Eval for structural changes, hemorrhage/ischemia/necrosis History: Suspected TIA and 2nd degree heart Brain MRIThere are multiple scattered restricted diffusion lesions on the left frontal, temporal and parietal lobes indicating acute ischemic stroke without evidence of hemorrhagic conversion.Scattered FLAIR high signal intensity lesions on the periventricular white matter and especially on the left side centrum semiovale indicate non specific small vessel ischemic disease.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.Small lipoma on the right temporal area.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased in-flow signal enhancement on the left ICA, however, there is no evidence of luminal stenosis. Otherwise the right ICA, bilateral MCAs and bilateral ACAs appear to be normal. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate sever luminal stenosis of the left proximal extracranial ICA, about 25mm above the left CCA bifurcation.Otherwise, normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the right common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Left hemispheric acute ischemic infarctions without evidence of hemorrhagic conversion as described above.2. Significant luminal stenosis of the left extracranial ICA about 25mm above the bifurcation.3. Normal brain MRA with evidence of either slow or decreased flow through the left ICA. Discussed and informed findings to Dr Brandt of Cardiology team.