Evaluate for ischemia: Aphasia. MRI: There is high T2 signal and restricted diffusion in the posterior limb of the left internal capsule. There is a scattered background of high T2 signal in the cerebral white matter without restricted diffusion and a punctate area of encephalomalacia in the left pons. There is no evidence of intracranial hemorrhage or mass. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: The images are degraded by motion. There is irregular narrowing of the bilateral posterior cerebral arteries, primarily involving the P2 segments. There is also redemonstration of severe steno-occlusive disease involving the intracranial right vertebral artery. The anterior circulation appears to be grossly intact. There is no evidence of cerebral aneurysms.
1. Recent infarct involving the posterior limb of the left internal capsule superimposed upon a chronic left pons infarct and probable chronic small vessel ischemic white matter disease.2. Irregular narrowing of the bilateral posterior cerebral arteries, primarily involving the P2 segments, and redemonstration of severe steno-occlusive disease involving the intracranial right vertebral artery.Discussed with Dr. Cheema at 1:50 PM on 10/12/15.