Male, 63 years old, with syncopal episode. Brain:No evidence of restricted diffusion is seen to suggest acute ischemia. No parenchymal edema or mass effect is detected. Three or four small foci of nonspecific white matter T2 hyperintensity are evident scattered in the cerebral hemispheres. Brain parenchymal morphology is within normal limits. No evidence of intracranial hemorrhage or any other abnormal extra-axial fluid is seen. The ventricular system is normal in size and morphology.Bone marrow signal characteristics are within normal limits. Mild paranasal sinus mucosal thickening and some polypoid nasal mucosal thickening is seen. There appears to be evidence of prior endoscopic sinus surgery. Incidental note is made of a 6 mm cyst with a fluid-heme level in the right parotid gland, likely of no clinical significance.MRA brain:The intracranial vessels demonstrate normal flow related signal. No evidence of any significant vascular stenosis or vascular occlusion is seen. No aneurysms are detected within the limitations of technique. The ACOM artery is unremarkable. A large left PCOM artery is present with fetal origin of the left PCA. A moderately sized right PCOM artery is present. The left vertebral artery is dominant.MRA neck:The origins of the great vessels are not well visualized likely due to noncontrast technique. No significant vascular stenosis is detected within the carotid circulation by NASCET criteria. The left vertebral artery is well visualized throughout the neck and is dominant. The right vertebral artery demonstrates only thready flow related signal throughout its entire cervical course. Given the correspondingly small size of the foramina transversaria on the right as noted on prior CT, this is almost certainly a congenital variation.
1.No evidence of acute ischemia or other acute intracranial abnormalities which would account for the patient's symptoms.2.Unremarkable MRA evaluation of the brain and neck vasculature.