Diagnosis: WeaknessClinical question: r/o strokeSigns and Symptoms: slurred speech, left sided weakness MRI brain: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.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is not a typical at this age and likely of little clinical significanceNormal 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 fetal origin of the posterior cerebral arteries bilaterally with the a hypoplastic left P1 segment and a medium sized right P1 segment. Intracranially the right vertebral artery is diminutive and predominantly supplies the right posterior inferior cerebellar artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.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. The left vertebral artery is larger than the right vertebral artery. The left vertebral artery is tortuous at its origin. There is mild narrowing at the origin of the left vertebral artery. The right vertebral artery has a long segment stenosis at its origin.
1.There is no evidence for acute ischemic cerebral infarction appreciated.2. There is mild narrowing at the origin of the left vertebral artery. Intracranially the right vertebral artery is diminutive and predominantly supplies the right posterior inferior cerebellar artery.3.No evidence for intracranial cerebrovascular occlusion.