Reason: eval for lesion History: aphasia MRI of the brainthere is diffusion restriction present knee right half of the corpus callosum with a couple punctate foci of diffusion restriction right centrum semiovale. There is a signal hyperintensity on T2 and flair line involving left basal ganglia including left caudate nucleus as well as left lentiform nuclei and adjacent centrum semiovale.T2 and flair signal hyperintensities are present along the globus pallidus bilaterally. More subtle T2 and flair signal hyperintensity is present along the brainstem especially at the pons, midbrain, left cerebral peduncle and also along the thalami.On susceptibility weighted imaging there is a focus of susceptibility effect present along the occipital horn of the right lateral ventricle. Punctate foci of susceptibility are present along the isthmus of the left cingulate gyrus, the subcortical white matter of the right occipital lobe. the right centrum semiovale, with a multiple foci of punctate susceptibility in the right cerebellar hemisphere , left cerebral hemisphere and in the pons.T1 signal hyperintensity in the left basal ganglia is present.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.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. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.There is fetal origin of posterior cerebral arteries present bilaterally. The anterior communicating artery is medium size.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 no significant stenosis along the course of the vertebral arteries.
1.Lesions are asymmetrically distributed in the basal ganglia - especially globus pallidi but also caudate nuclei, thalami, left putamen, left centrum semiovale, corpus callosum and brainstem. In the appropriate clinical settings this pattern is suggestive of toxic/metabolic such as carbon monoxide poisoning, extrapontine myelonolysis, Wilson's disease or viral encephalitis. Please correlate with clinical findings.2.Microhemorrhages distributed in a pattern suggestive of hypertension.3.No evidence for intracranial aneurysm.4.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.5.Findings were discussed with the referring physician.