Diagnosis: AphasiaClinical question: stroke wuSigns and Symptoms: aphasia MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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. The eyeball lenses are thin.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. On the prior exam, the distal right M1 segment at its junction with M2 segment appears narrower on this MRA exam, however, this is also associated with the tortuosity of the vessel as well as a smaller right internal carotid artery relative to the left internal carotid artery suggesting that this may very well be a flow related phenomenon rather than a stenosis.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is very small. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is 50% narrowing at the origin of the left vertebral artery.The walls of the distal cervical internal carotid arteries and distal vertebral arteries are irregular and have a cobblestone.
1.No evidence for intracranial cerebrovascular occlusive disease.2.Findings are suggestive of arterial with these such as fibromuscular dysplasia involving the distal vertebral arteries and distal cervical internal carotid arteries.3.50% narrowing at the origin of the left vertebral artery.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for acute ischemic cerebral infarction.