58 years Female (DOB:11/15/1958)Reason: MLF lesion? History: Internuclear ophthalmoplegiaPROVIDER/ATTENDING NAME: PHILIP A VERHOEF Brain MRIRedemonstration of multifocal bihemispheric, supra and infratentorial diffusion restriction lesions including bilateral cerebellar hemispheres, left temporal lobe, and the right frontal lobe. In particular, there is a focal restricted diffusion on the left side inferior aspect of midbrain likely located at the left medial longitudinal fasciculus (series 502, image 96).On FLAIR/T2, corresponding restricted diffusion lesions show high signal intensity indicate these lesions are subacute ischemic infarcts.In addition, there are multiple bilateral lateral periventricular white matter as well as centrum semiovale FLAIR/T2 high signal intensity lesions which most likely represent nonspecific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Neck MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate significant tortuosity of extracranial bilateral carotid arterial system. However, there is no evidence of significant (more than 50%) luminal stenosis on both intracranial and extracranial arterial system. Vertebrobasilar system appears to be normal.
1. Multifocal ischemic infarctions involving bilateral cerebral hemispheres, cerebellum and midbrain. In particular, a focal ischemic infarction involving left medial longitudinal fasciculus. 2. Non specific small vessel ischemic disease.3. No evidence of significant luminal stenosis on both intracranial and extracranial arterial system.