Clinical question: Assess for new stroke/metastases/other lesions that may trigger seizure. Signs and symptoms: New onset of seizures, old right MCA stroke, colon cancer. Pre and post enhanced brain MRI:Limited exam due to significant motion artifact.No acute intracranial process and negative diffusion weighted series.Examination demonstrates extensive right hemispheric encephalomalacia consistent with a large right MCA territory. Findings results in ex vacuo dilatation of right lateral ventricle and widening of cortical sulci. Additionally study demonstrates fairly extensive periventricular confluent foci of FLAIR hyperintensity consistent with extensive chronic small vessel ischemic strokes. There is evidence of right sided biliary and degeneration. Images through posterior fossa demonstrate multiple foci of FLAIR hyperintensity in the pons suggestive of chronic lacunar infarcts.There is no detectable abnormal enhancement of brain parenchyma or the leptomeninges to suggest metastatic disease.Calvarium demonstrates normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal patterns.Nonenhanced brain MRA:Examination demonstrates patent and unremarkable bilateral internal carotid arteries. Unremarkable bilateral anterior cerebral arteries. Unremarkable left middle cerebral artery and its branches. Patent right middle cerebral artery however with paucity of distal branches compared to the left representing changes from patient's known large chronic right MCA territory stroke.Pre and post enhanced neck MRA:The visualized aortic arch is unremarkable.The origins of major vessels are all patent and unremarkable.Brachiocephalic and bilateral subclavian are patent and unremarkable.Bilateral vertebral arteries are patent and unremarkable.Bilateral common carotid arteries are patent and unremarkable.There is mild atherosclerotic disease at the origin of right internal carotid artery without significant stenosis and unremarkable otherwise.There is a short segmental moderate stenosis at the origin of left internal carotid artery due to a short segment of atherosclerotic plaque and unremarkable otherwise.
1.Brain MRI is exam due to extensive motion artifact. No evidence of an acute intracranial process and no detectable metastases lesions. Large chronic right MCA territory ischemic stroke, extensive chronic small vessel ischemic disease including chronic lacunar infarcts as detailed. Stable significant parenchymal volume loss with ex vacuo dilatation of the supratentorial ventricular system and cortical sulci.2.Nonenhanced brain MRA demonstrates patency of all intracranial major branches however with paucity of distal branches of right MCA.3.MRA of neck demonstrate a short segmental moderate vascular stenosis at the origin of the left internal carotid artery, mild atherosclerotic disease at the origin of the right internal carotid artery and unremarkable exam otherwise.