Diagnosis: Transient cerebral ischemic attack, unspecifiedClinical question: Right facial numbnessSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are several punctate T2 and FLAIR hyperintense lesions present in the pons and thalami.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A 12 x 10 mm axial dimension mass is present in the deep right parotid gland which is very bright on T2 ,bright on FLAIR and low signal on T1. It is homogeneous and well circumscribed.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 right A1 segment is larger than the left A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The left vertebral artery is larger than the right vertebral artery.
1.No evidence for intracranial cerebrovascular occlusive disease.2.No evidence for acute ischemic cerebral infarction.3.Periventricular and subcortical white matter lesions of a mild to moderate degree and several punctate lesions in the pons and thalami are nonspecific. At this age they are most likely vascular related. 4.A small right deep parotid gland mass is present. Statistically it most likely represents pleomorphic adenoma though malignancy cannot be excluded. A follow-up exam would help further evaluate it.