63 years Female (DOB:10/13/1952)Reason: right parietal stroke History: left face, arm weakness, left gaze/neglectPROVIDER/ATTENDING NAME: JAMES J WALTER RICHARD A KRAIG MRI of the brainThere is a focus of diffusion restriction present measuring approximately 34 x 18 mm axial dimensions which involves the precentral gyrus and some of the postcentral gyrus extending down to the level of the subcentral lobule in superiorly to the level of the hand motor area. It is of high signal on T2 and FLAIR MR imaging. It measures approximately 51 x 27 mm in coronal dimensions.There is a focus of encephalomalacia present along the left superior frontal gyrus posteriorly extending to the left middle frontal gyrus. Another focus of encephalomalacia is present in the left occipital lobe involving the left cuneus. Another focus of encephalomalacia is present along the right cerebellar hemisphere.There are punctate foci of signal loss on susceptibility imaging predominantly involving basal ganglia and midbrain .There is a moderate to marked degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.The patchy foci of signal hyperintensity on T2 and FLAIR MRI in the brainstem.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.Exam is degraded by patient motion which may obscure more subtle abnormalities.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 60% stenosis present along the ophthalmic segment of the left internal carotid artery measuring approximately 12 mm in length.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right posterior communicating artery is larger than the left posterior communicating artery. The right posterior communicating artery is medium-sized whereas the left posterior communicating arteries there are small. Anterior communicating artery is small. The left vertebral artery is larger than the right vertebral artery.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 appreciated along the course of the vertebral arteries. However, the proximal vertebral arteries are not imaged adequately.There are nodular lesions present in the thyroid gland which are not adequately evaluated on this exam.
1.Findings are compatible with acute ischemic cerebral infarction involving right pre and postcentral gyri.2.There is a 60% stenosis present at the left internal carotid artery ophthalmic segment.3.There are multiple foci of encephalomalacia present which include left frontal lobe, left occipital lobe, and right cerebellar hemisphere. In general these are suspected to be of ischemic origin.4.There are microhemorrhages predominantly involving basal ganglia and upper midbrain. This pattern is suggestive of hypertension.5.Periventricular and subcortical white matter lesions of a moderate to marked degree are nonspecific. At this age they are most likely vascular related. 6.Patchy lesions in the brainstem are also likely vascular related.7.The proximal vertebral arteries are not imaged adequately. No obvious stenosis is appreciated in the proximal vertebral arteries.8.Exam is degraded by patient motion which may obscure more subtle abnormalities.9.There are nodular lesions present in the thyroid gland which are not adequately evaluated on this exam.