87 years Female (DOB:8/17/1929)Reason: stroke History: fallPROVIDER/ATTENDING NAME: SANGEETA S SAKARIA THOMAS J. KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated. The lateral ventricles are fairly large as is the third ventricle.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions as well as hyperintense lesions within the brainstem of a moderate degree identified on the FLAIR and T2 images. Compared to prior exam these brainstem lesions appear to have accumulated further whereas the periventricular and subcortical white matter lesions appear relatively stable.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 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. There are infundibula at the origins of the callosomarginal arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is very small.. There is fetal origin of the right posterior cerebral artery. The left posterior communicating artery is medium-sized. The right P1 segment is hypoplastic. There is infundibulum at the origin of the right posterior cerebral artery and left posterior communicating arteries. The right vertebral artery is larger than the left vertebral artery.Visualized images of the upper cervical spine demonstrate degenerative changes which are best seen on the recent CT of the cervical spine.
1.No evidence for intracranial cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.Periventricular and subcortical white matter lesions of a moderate degree as well as a moderate degree of brainstem lesions are nonspecific. At this age they are most likely vascular related. Compared to prior exam from June 2014 these brainstem lesions appear to have accumulated further whereas the periventricular and subcortical white matter lesions appear relatively stable.4.Large ventricular system could be related to atrophy though it is possible it is related to normal pressure hydrocephalus. Please correlate clinical symptoms.5.Refer to CT of the cervical spine for further comments.