60 years Female (DOB:1/31/1956)Reason: r/o vasculitis or other abnormality History: encephalopathyPROVIDER/ATTENDING NAME: TRISHA V SHETH FERNANDO D. GOLDENBERG MRI of the brainThere are multiple foci of diffusion restriction present. One located in the right temporal lobe centered along the midportion of the right temporal lobe measures 27 x 38 mm axial dimensions and is associated with T1 signal hyperintensity and susceptibility effect. One extends from the trigone of the left lateral ventricle to the watershed between parietal and occipital lobes measuring approximately 21 x 29 mm. There are multiple smaller lesions in the periventricular white matter as well as a splenium of the corpus callosum. Compared to the prior exam diffusion restriction in some of the lesions previously seen has regressed indicating continued evolution. There is no clear-cut new lesion appreciated.There are multiple foci of susceptibility effect scattered throughout the brain including subcortical white matter, basal ganglia, thalami, brainstem, cerebellum and corpus callosum. These were also present on the previous exam and have evolved but do not appear to have changed significantly specifically the right temporal lobe lesion which was earlier subacute stage a few weeks ago is now a later subacute stage.There is gyriform enhancement present along the left occipital and parietal lobes. This corresponds to area of a early subacute infarction on the 5/24 exam.The visualized portions of the paranasal sinuses demonstrate large mucous retention cyst in the right maxillary sinus and mucosal thickening within the paranasal sinuses. The visualized portions of the mastoid air cells are partially opacified. 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.The intracranial distal vasculature appears attenuated. There are stenosis present along the right p3 segment of the right posterior cerebral artery. There also appear to be multiple foci of dilation and narrowing of the intracranial cerebral vasculature. Similarly there appears to be stenoses along the pericallosal and callosomarginal arteries at the A3, a4 and a5 segments as well as the middle cerebral arteries distally at the M2, M3 and M4 segments. This appearance has not changed significantly compared to the previous exam.The anterior communicating artery is identified. The right posterior communicating artery is medium-sized. The left posterior communicating artery is very small. Anterior communicating artery is also very small.
1.There are multiple ischemic infarctions within the supratentorial brain and the multiple hemorrhagic infarctions scattered throughout the brain. These continue to evolve relative to prior exams. No new ischemic or hemorrhagic lesions are appreciated.2.MR angiography demonstrates distal intracranial cerebrovascular occlusive disease. One possibility is that this is related to vasculitis or vasculopathy another possibility is that this represents atherosclerotic intracranial small vessel occlusive disease. Given the patient's clinical history, small vessel intracranial atherosclerotic vasculopathy is favored over vasculitis.