66 yo male with new onset vertigo and cerebellar ataxia MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate T2/FLAIR hyperintense lesion in the right posterior limb of the internal capsule.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 right A1 segment is hypoplastic. The posterior communicating arteries are intact. There is fetal origin of the right PCA. The right p1 segment is hypoplastic. 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 almost 50% stenosis at the origin of the left vertebral artery and mild narrowing at the origin of the right vertebral artery.
1.There is no evidence for acute ischemic cerebral infarction.2.There is a small left posterior limb of internal capsule lesion present which is nonspecific but suspected to be vascular related.3.There is a 50% stenosis at the origin of the left vertebral artery.