The left face arm and leg weakness and paresthesia with rapid improvement. No evidence of acute ischemic or hemorrhagic lesion.Multifocal patchy high signal intensities on bilateral periventricular white matter indicate non specific small vessel 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, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate less than 50% of luminal narrowing on the right MCA proximal M1 segment and more than 50% of luminal narrowing on the left distal ICA. Bilateral PCAs are fetal origins. It appears to be that there is one large ACA indicating Azygos ACA. Left ACA A1 segment is hypoplastic. Acom artery is patent. No evidence of intracranial aneurysm. Vertebrobasilar system appears to be normal.3D 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.
1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Multifocal intracranial arterial luminal stenosis, right MCA proximal M1 (less than 50% stenosis) and left distal ICA (more than 50% stenosis). 3. Normal extracranial craniocervical arterial system. Comment: although the patient appears to be asymptomatic on the left distal ICA stenosis, bilateral various degreed intracranial arterial luminal stenosis indicate intracranial atherosclerosis. Therefore, precise evaluations and management are suggested. If indicated, clinical follow up through Dr.Brorson of Neurology is suggested. 