Reason: altered mental status to evaluate for stroke History: weakness, altered mental status MRI of the brainThere is a focus of diffusion restriction present along the left half of the splenium of the corpus callosum.There is a mild to moderate degree of periventricular and subcortical punctate and partly confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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. The left eye lens is thin.MRA brain:Exam is degraded by patient motion.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The distal left PCA at the P3 segment appears slight more attenuated than the left.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The left A1 segment is small. The posterior communicating arteries are intact. The vertebral arteries are asymmetric in size - left larger than right.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. There is a moderate amount of patient motion present. Antegrade flow in the carotid and vertebral vasculature can be discerned, however, stenosis may be obscured by the motion artifact.
1.Exam is degraded by patient motion which may obscure subtle abnormalities.2.There is an acute/subacute infarction involving the left half of the splenium of the corpus callosum.3.The distal left PCA at the P3 segment appears slight more attenuated than the left. However, given the patient motion this may very well be artifactual.4.There is antegrade flow in the cervical vertebral and carotid arteries, however, stenosis may be obscured by the motion artifact.5.Periventricular and subcortical white matter changes of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 6.If additional information is needed, a CTA may be helpful given its shorter acquisition time relative to MRI/MRA