58 years Male (DOB:7/26/1957)Reason: Evaluate for steno-occlusive disease, etiology of RUE weakness History: RUE weaknessPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainThere is a focus of diffusion restriction present involving the posterior aspect of the left putamen and extending into the left centrum semiovale measuring approximately 25 x 9 mm in axial dimensions. Another focus of diffusion restriction is present in the left centrum semiovale more anterior measuring approximately 9 x 9 mm axial dimensions. These are also high signal on T2 MRI imaging sequences.The appears to be a small focus of encephalomalacia in the right medial occipital lobe which although has some high signal on diffusion-weighted imaging and is high signal is also present on the ADC maps indicating that it may very well represent T2 shine through rather than diffusion restriction..Punctate T2 signal hyperintense foci are present in the brainstem.Please note that T2 imaging is markedly compromised due to patient motion artifact.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 demonstrate opacification of the left maxillary sinus and left anterior ethmoid air cells as well as part of the left frontal sinus. This would indicate nonocclusive pattern in the left hiatus semilunaris potentially.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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 left vertebral artery smaller than the right vertebral artery. There is extracranial origin of the left posterior inferior cerebellar artery. The posterior communicating arteries are small. The anterior communicating artery is small.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified.
1.No evidence for cerebrovascular occlusive disease.2.Findings are compatible with a small foci of infarction in the left centrum semiovale and basal ganglia3.Findings suggest old focus of encephalomalacia in the right occipital lobe possibly related to prior infarction.4.Findings are compatible with the paranasal sinuses obstructive pattern centered in the left hiatus semilunaris.5.Examination is compromised due to patient motion artifact. Additionally, the patient refused to complete the exam due to claustrophobia. This may compromise both interpretation and identification of additional lesions.