Diagnosis: Dizziness and giddinessClinical question: Eval vasculature in stroke wuSigns and Symptoms: vertigo MRI of the brainNo diffusion weighted abnormalities are appreciated.There are multiple punctate foci of signal hypointensity scattered in the brainstem, thalami and basal ganglia as well as the deep gray nuclei of the cerebellum. Additionally there are a couple periventricular punctate foci of susceptibility as well as one in the left inferior frontal gyrus.There are punctate foci of T2 signal hyperintensity without FLAIR hyperintensity in the areas where there is susceptibility effect.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.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 vertebral arteries.
1.Multiple microhemorrhages are present in the brain as detailed above which are in a pattern suggestive of hypertension.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.4.No evidence for acute ischemic cerebral infarction5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 