Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: Evaluate for ischemia and vessel wall History: L BG infarct on prior MRI, RUE distal weakness There are eccentric intracranial arterial wall thickenings including right distal cervical ICA and petrous ICA junction, right distal ICA, right MCA, left ICA cavernous sinus segment, left MCA proximal M2 segment indicating atherosclerotic changes.These lesions show relatively homogenous enhancement of wall thickening except left ICA cavernous sinus segment lesion. The lesion shows enhancement of intimal and adventitia side but not core of the wall thickening. Thus, this lesion can be regarded as a vulnerable plaque.The leftThe left basal ganglia ischemic lesion shows enhancement indicating luxury perfusion status.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.
1. Multifocal intracranial arterial eccentric wall thickening involving left ICA cavernous sinus segment, left MCA proximal M2 segment, right distal ICA, right MCA indicating possibility of atherosclerotic changes. 2. Differential diagnosis include vasculitis, vasospasm, or focal dissection with underlying atherosclerosis. 