Diagnosis: Cerebral infarction due to unspecified occlusion or stenosis of left anterior cerebral arteryClinical question: please check vessel patencySigns and Symptoms: right sided weakness MRI of the brainA focus of diffusion restriction measuring approximately 7 mm in size is present along the posterior limb of the left internal capsule extending to involve the basal ganglia. This is associated with some T2 and FLAIR signal hyperintensity.There are subcentimeter foci of T2 and FLAIR signal hyperintensity present in the thalami, basal ganglia and cerebellar hemispheres bilaterally without associated diffusion restriction. There are patchy foci of T2 and FLAIR signal hyperintensity in the pons.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.The right vertebral artery flow-void is absent, though the right vertebral artery is identified and is small.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.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 is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the posterior cerebral arteries bilaterally. The P1 segments are medium-sized. The right vertebral artery is not readily identified.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 mild narrowing at the proximal left vertebral artery. This is approximately 30% narrowing.The right vertebral artery is diminutive and stenotic proximally. It is not identified above the C1 level.
1.Subacute lacunar infarction involving the posterior limb of the left internal capsule.2.Multiple lesions in the basal ganglia, cerebellum and thalami which are compatible with prior lacunar infarcts3.Patchy lesions in the brainstem as well as periventricular and subcortical white matter lesions are present which are most likely vascular related.4.Findings suggest occlusion of the right vertebral artery distally.