Unspecified cerebral artery occlusion with cerebral infarction [434.91], Reason for Study: ^Reason: assess for new stroke, h/o numerous strokes in posterior circulation History: assess for new stroke, h/o numerous strokes in posterior circulation. Brain MRI:Multifocal scattered diffusion restriction lesions on the left basal ganglia, left external capsule, left cerebellar hemisphere and left inferior thalamus indicating acute ischemic infarction without evidence of hemorrhagic transformation.There are multifocal tissue defects indicating prior ischemic infarctions including right external capsule, left upper pons, and left cerebellar hemisphere.Underlying brain shows multiple patchy high signal intensities on FLAIR images on bilateral periventricular white matter indicate 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. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal intracranial arterial luminal stenosis. Especially the left MCA distal M1 segment shows more than 70% of luminal stenosis. The right MCA M1 segment shows luminal irregularities but without significant (more than 70%) stenosis. The vertebrobasilar system shows luminal irregularity of the basilar artery and bilateral PCAs without significant luminal narrowing. The distal left vertebral artery lumen is narrowed and irregular. In addition, the C1 and C2 portions of the left vertebral artery are smaller than that of the right side indicating possible hypoplastic nature or could be atherosclerotic stenosis. Neck MRA:3D 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 left vertebral artery origin shows about less than 50% luminal stenosis, however, this could be an artifactual finding. There is focal luminal stenosis at the level of C1-skull base junction which could represent atherosclerotic stenosis.There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Multifocal acute ischemic strokes on the left basal ganglia, external capsule and left cerebellar hemisphere without evidence of hemorrhagic transformation.2. Multifocal various degree intracranial arterial luminal stenosis indicating atherosclerotic changes of intracranial arterial system. Especially the left MCA distal M1 segment stenosis appears to be significant (more than 70% stenosis).3. No evidence of significant (more than 50%) luminal stenosis of extracranial arterial system except the left vertebral artery ostium. 