Other cerebrovascular disease [I67.89], Brain MRIThere is focal restricted diffusion without evidence of hemorrhagic transformation at the left basal ganglia. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal irregularities of intracranial arterial system. In particular, distal right ICA, distal right MCA M1 segment and right MCA genu, proximal basilar artery, and superior aspect of the right MCA M1 segment indicate intracranial relatively larger vessel involving pathology such as intracranial atherosclerosis, vasculitis, RCVS or underlying atherosclerosis with left MCA M1 segment dissection. There is no intracranial arterial aneurysm.
1. Acute ischemic infarction on the left basal ganglia without hemorrhagic conversion.2. Multifocal intracranial arterial luminal irregularities and stenosis. Differential diagnosis include intracranial atherosclerosis, vasculitis, RCVS and focal left MCA M1 segment dissection with underlying atherosclerosis. 