64-year-old male presents with left-sided facial droop. MRI Head: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is global parenchymal volume loss. Mild scattered periventricular and subcortical white matter T2 hyperintensity. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a partially empty sella. There is patchy opacification of the left anterior ethmoid air cells. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. The right A1 segment of the anterior cerebral artery is hypoplastic No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.
1. Mild scattered periventricular and subcortical white matter T2 hyperintensity may represent chronic small vessel ischemic disease, but no evidence of acute infarct.2. Mild scattered likely chronic small vessel ischemic disease.3. No high-grade stenosis involving the intracranial or neck arteries.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.