70 years Female (DOB:11/4/1945)Reason: Speech change, ams? History: Speech change, ams?PROVIDER/ATTENDING NAME: PETER C WARNKE PETER C WARNKE MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional patchy T2 and FLAIR signal hyperintensity is present in the basal ganglia, thalami and brainstemA mild degree of punctate foci of signal loss on SWI are identified in the subcortical white matter . There is a left sided subependymal focus of susceptibility. Additional foci o punctate sized susceptibility are present in the thalamiThe CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate minor mucosal thickening. 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 posterior communicating arteries are intact. The right PCOMA is large. The left PCOMA is small. The vertebral arteries are similar in 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 40% stenosis at the LICA origin by NASCET criteria.There is no significant stenosis along the course of the vertebral arteries. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is facet hypertrophy at this level (left more than right).At L4-5 there is no significant compromise to spinal canal or neural foramina. There is disk dessication and a disk bulge at this level associated with facet and ligamentum flavum hypertrophy..At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina. At L1-2 there is no significant compromise to spinal canal or neural foramina.
1. 40% stenosis at the LICA origin by NASCET criteria.2.Periventricular and subcortical white matter lesions of a moderate degree and lesions in the basal ganglia, thalami and brainstem are nonspecific. At this age they are most likely vascular related. 3.Mild degree of predominantly thalamic and subcortical microhemorrhages. This is a non-specific pattern which may imply combination of more than one cause (i.e. amyloid angiopathy and hypertension)4.Mild degenerative are present in the lumbar spine without significant compromise to the spinal canal or exiting nerve roots.