Diagnosis: Other symptoms and signs involving the musculoskeletal system Other lack of coordinationClinical question: is there signs of acute stroke?Signs and Symptoms: 3days of RUE dysmetria and LE weakness MRI of the brainThere is a focus of diffusion restriction involving the anterior aspect of the right lentiform nuclei which extends into the right centrum semiovale.There is a moderate to marked degree of periventricular confluent T2 and FLAIR signal hyperintensities.There are punctate foci of T2 and FLAIR signal hyperintensity involving the brainstem, thalami and basal ganglia bilaterally.There are foci of encephalomalacia present along the occipital poles bilaterally involving the right occipital pole more than the left. There is associated ex vacuo effect on the trigones and occipital horns of the lateral ventricles.There is encephalomalacia involving the cerebellar hemispheres bilaterally with signal change in the cerebellar white matter and ex vacuo effect on the fourth ventricle. The right middle cerebellar peduncle is atrophicIncidental note is made of partial empty sella.No abnormal 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 and the proximal anterior, middle and posterior cerebral arteries. The vertebral arteries are identified only piecemeal. The right vertebral artery appears to be occluded and the left vertebral artery is only identified in small portions. The basilar artery appears to be occluded between the superior cerebellar arteries and the anterior inferior cerebellar artery. The posterior communicating arteries are identified. The left posterior communicating artery appears to be small in the right posterior communicating artery is not readily identified. The cerebellar arteries are not readily identified. Small portion of the left posterior inferior cerebellar artery is identified and a small portion of the right anterior inferior cerebellar artery is identified. It is suspected that these 2 vessels are likely dominant branches.The left posterior cerebral artery appears larger than the right posterior cerebral artery. The right posterior cerebral artery is not identified beyond the proximal P2 segment. The left posterior cerebral artery is not readily identified beyond the mid to distal P3 segment.The internal carotid arteries and proximal anterior and middle cerebral arteries are irregular with areas of only mild narrowing and dilation. There is approximately 40% narrowing at the proximal left middle cerebral artery M1 segment. There is also approximately 40% narrowing at the communicating segment of the left internal carotid artery. There are foci of narrowing in many of the middle cerebral artery and anterior cerebral artery branches present.The anterior communicating artery is identified and is medium sized. The MRA of the brain is degraded due to some motion artifact.
1.There is a subacute infarction involving the right lentiform nuclei and adjacent centrum semiovale.2.Findings suggest significant vertebrobasilar disease with suspected occlusion of the right vertebral artery and basilar artery and significant stenosis along the left vertebral artery. Please note that the MRA of the brain is degraded due to motion artifact which may obscure the intracranial vasculature especially in the setting of stenoses and occlusions.3.Findings suggest stenosis or occlusion along the right P2 segment and the left P3/P4 segments. Please note that the MRA of the brain is degraded due to motion artifact which may obscure the intracranial vasculature especially in the setting of stenoses and occlusions.4.There are multiple foci of atherosclerotic narrowing throughout the intracranial vasculature.5.There are multiple old lacunar infarcts involving the thalami, basal ganglia and brainstem.6.Multiple foci of encephalomalacia in the cerebellum, right middle cerebellar peduncle and occipital poles bilaterally are most likely vascular related.