Weakness, [728.87], right facial droop, slurred speech There is a focal restricted diffusion on the left basal ganglia (posterior aspect of. Putamen) indicate acute ischemic infarct. There is no evidence of hemorrhage transformation.Underlying brain shows multifocal encephalomalacia especially on the right external capsule anteriorly will internal capsule indicating chronic ischemic infarct.FLAIR imaging shows patch bihemispheric periventricular white matter high signal intensity indicate nonspecific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, 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.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate a moderate (about 50-70%) stenosis on the mid basal artery. In addition, subtle irregularities of bilateral MCA M2 segments indicate intracranial arthrosclerotic changes. However, there is no evidence of intracranial arterial hemorrhage or occlusion.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. Bilateral vertebral artery origins appear to be narrowed about 50%. Although tortuous, there is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries. No evidence of luminal stenosis.
1. Acute ischemic infarction, left posterior aspect of putamen without hemorrhagic transformation.2. Multifocal chronic ischemic infarctions as well as minimal non specific small vessel ischemic disease.3. Mild atherosclerotic changes of intracranial arterial system including moderate (50-70%) luminal narrowing of mid basilar artery.4. No significant (more than 70%) luminal stenosis on both extracranial and intracranial arterial system. No intracranial aneurysm. No occlusion of arterial system. 