Diagnosis: Cerebral infarction, unspecifiedClinical question: eval for stenosisSigns and Symptoms: stroke syndrome presenting with 2d h/o left sided weakness, and mildly slurred speech MRI of the brainThere is a focus of diffusion restriction present in the right posterior limb of the internal capsule. It is hyperintense on T2 and FLAIR MRIPunctate foci of T2 and FLAIR hyperintensity without diffusion restriction are present in the thalami, basal ganglia, left cerebellar hemisphere and left cerebral peduncle. A patchy focus of T2 and FLAIR signal hyperintensity is present in the left brainstem extending from the left cerebral peduncle to the left medulla.There is a low signal focus present in the right caudate nucleus on susceptibility weighted imaging.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 small. 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. The LCCA originates from the innominate artery.
1.There is a subacute lacunar infarct present in the right posterior limb of internal capsule.2.An old small hemorrhage is present in the right caudate nucleus where the is not encephalomalacia.3.Multiple old lacunar infarcts are present in the basal ganglia and brainstem. It is possible that a patchy lesion along the left brainstem represents wallerian degeneration.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease present.