74 years Male (DOB:1/21/1942)Reason: Dr. Christoforidis acute stroke protocol to evaluate if candidate for IR intervention with MR perfusion History: rt sided weaknessPROVIDER/ATTENDING NAME: DAVID A HARTER DAVID G. BEISER MRI of the brainThere are multiple foci of diffusion restriction present. One in the right cerebellar hemisphere measures 33 x 28 mm axial dimensions. There are several smaller 1's scattered in both cerebellar hemispheres. There is a focus of diffusion restriction involving the left lingual and fusiform gyri as well as the left hippocampus measuring approximately 75 x 22 mm axial dimensions. Another focus of diffusion restriction is present in the left thalamus which measures 11 x 9 mm axial dimensions. Another one present in the left cuneus measures 5 mm in size. Many of these are associated with FLAIR signal hyperintensity with the exception of the left thalamic lesion.Perfusion imaging is suboptimal due to early triggering.There is a moderate 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. No abnormal 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 demonstrate mucous retention cysts. 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 right posterior cerebral arteries.There is occlusion of the left posterior cerebral artery at the proximal P2 segment. There is focal narrowing of the mid basilar artery with approximately 50% stenosis.The right vertebral artery is larger than the left vertebral artery. The left posterior inferior cerebellar artery is not readily identified though the right posterior inferior cerebellar artery is relatively larger.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The right A1 segment is hypoplastic. The posterior communicating arteries are small to medium sized.
1.There are multiple foci of cerebral infarction manifested there is diffusion restriction in the posterior circulation involving left medial temporal lobe, left occipital lobe and the cerebellar hemispheres.2.There is occlusion of left posterior cerebral artery at the proximal P2 segment.3.50% focal stenosis at the mid basilar artery.4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.Perfusion imaging is suboptimal due to early triggering.Findings were reported to Dr ALSHAIKH, JUMANA TARIQ