85 years Female (DOB:8/21/1930)Reason: LMCA History: LMCAPROVIDER/ATTENDING NAME: DAVID A HARTER JACQUELINE T BERNARD MRI of the brainThere is a focus of diffusion restriction present involving grey and white matter which includes the left inferior parietal lobule and some of the adjacent brain parenchyma including left post central gyrus and the posterior aspect of the insular cortex. There is associated sulcal effacement and FLAIR and T2 signal hyperintensity.There is a moderate degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.There are patchy foci of T2 and FLAIR signal hyperintensity within the brainstem.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. 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 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.The left angular and posterior parietal arteries are not readily identified.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is large. The left A1 segment is hypoplastic. There is fetal origin of the right PCA. The left posterior communicating arteries are intact. The left vertebral artery is not identified.There is 30% narrowing of the basilar artery below the level of the AICA origins.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 occlusion of the LVA at its origin with some collateral reconstitution distally.
1.There is a left parietal lobe subacute stage infarction as detailed above. There is no evidence for associated acute intracranial hemorrhage.2.The left angular and posterior parietal arteries are not readily identified. Given the infarction, this suggests occlusion of these branches of the left MCA.3.LVA occlusion4.Periventricular and subcortical white matter signal changes are nonspecific. At this age they are most likely vascular related though they could be related to a neurodegenerative process such as nonspecific leukoencephalopathy of aging. 5.Signal changes in the brainstem are most likely vascular related .