Slurred speech [R47.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: AMS, h/o CVA History: AMS Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.Focal encephalomalacia on the left thalamus and external capsule indicate chronic ischemic infarction.Scattered high FLAIR high signal intensity lesions on bilateral periventricular white matter and centrum semiovale suggest mild non specific small vessel ischemic disease. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Retention cyst on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin.Right distal vertebral artery is hypoplastic, otherwise vertebrobasilar system appears to be normal.There is no intracranial arterial aneurysm or significant luminal stenosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarction involving left thalamus and external capsule with underlying non specific small vessel disease. 3. No evidence of significant luminal stenosis on bilateral CCAs, ICAs and vertebrobasilar system. 4. No evidence of intracranial arterial aneurysm.