 MRI:There is patchy diffusion restriction in the left MCA distribution involving the left posterior frontal lobe corona radiata extending to the left insula compatible with acute infarct. This is associated with mildly increased T2 signal. There is additional periventricular and subcortical T2 hyperintensities without associated diffusion restriction which likely represent chronic small vessel ischemic disease. Ventricles and sulci are slightly prominent which may reflect a mild degree of volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA:There is evidence of intracranial atherosclerotic disease without high grade stenosis. There is ectasia of the bilateral cavernous and supraclinoid carotid arteries with multiple areas of apparent outpouching measuring 2-3-mm. Extracranial internal carotid are patent. There is slightly diminished flow within the distal left MCA branches compared to the right at the level of the sylvian fissure. No proximal high grade occlusion is visualized. The anterior cerebral arteries are patent. The vertebro-basilar system is patent without aneurysm or high-grade stenosis.
1.Acute infarcts in the left posterior frontal lobe in the left middle cerebral artery territory. 2.Mild chronic small vessel ischemic disease.3.Motion degraded MRA. Slightly diminished flow within the left distal MCA branches compared to the right. No proximal large vessel occlusion. 4.Multiple apparent 2-3 mm outpouchings within the cavernous and supraclinoid carotid arteries may possibly represent small aneurysms versus artifact. CTA or repeat MRA at 3T should be considered.