Cerebral infarction due to embolism of unspecified cerebral artery [I63.40], Reason for Study: ^Reason: stroke History: l hemiparesis Brain MRIThere is restricted diffusion lesion on the right internal capsule posterior limb as well as part of the right basal ganglia. On gradient echo images, there are multiple susceptibility lesions on bilateral thalami as well as right basal ganglia indicating either parenchymal calcification or chronic petechial hemorrhagic lesions. Among them, the lesion on the right basal ganglia is more likely on the external capsule aspect, therefore, this does not represent evidence of hemorrhage transformation. Without evidence of hemorrhage transformation of acute ischemic lesion.Underlying brain shows multiple patch bihemispheric periventricular white matter high signal intensity on FLAIR and T2-weighted images indicating nonspecific small vessel ischemic disease.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. Normal flow voids are identified in the major intracranial vessels. 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 possible focal luminal stenosis on the right MCA proximal M1 segment and right vertebrobasilar junction. Since MRA can exaggerate the degree of luminal stenosis, CTA can be considered for further imaging evaluation if clinically indicated.Bilateral distal ICAs and basilar artery appear to be slightly ectatic which represent atherosclerotic changes.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate 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 bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. Again bilateral CCAs and extracranial ICAs show ectatic changes with tortuosity indicating atherosclerotic changes.
1. Acute ischemic infarction on the right internal capsule posterior limb and globus pallidus without evidence of hemorrhagic conversion.2. More than 50% luminal stenosis of the right MCA proximal M1 segment and right vertebrobasilar junction as described above. CTA can be considered for further imaging evaluation.3. No evidence of extracranial arterial luminal stenosis. 4. Atherosclerotic changes of both intracranial and extracranial arterial system. 