Transient alteration of awareness [R40.4], Reason for Study: ^Reason: r/o stroke History: AMS, ?left sided weakness Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There are multifocal lacunar infarcts involving mid Pons especially on the right side, left thalamus and the left frontal lobe.Scattered T2/FLAIR high signal intensity lesions on periventricular white matter are seen, these are nonspecific but may indicate small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. The midline structures and cranial-cervical junction are normal.The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multiple various degreed intracranial arterial luminal stenosis and irregularity are seen indicating atherosclerotic changes. In particular, left internal carotid artery cavernous sinus segment shows significant signal loss suggesting about 50% of luminal stenosis. Vertebrobasilar system hypoplastic left distal vertebral artery otherwise vertebrobasilar system appears to be normal.No intracranial arterial aneurysm is seen.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal lacunar infarcts involving mid Pons left side, left thalamus, and left frontal lobe.3. Minimal nonspecific small vessel ischemic disease.