60 years Male (DOB:7/24/1955)Reason: Acute ishcmeic stroke History: acute ischemic strokePROVIDER/ATTENDING NAME: IMRE T NOTH IMRE T NOTH MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Patchy foci of diffusion restriction associated with FLAIR signal hyperintensity are present along the watershed zones of both right and left hemispheres. The infarctions are larger on the right versus the left side. Several punctate foci of diffusion restriction are present in the right temporal lobe and left temporal lobe.There is redemonstration of a 9mm signal hypointense nodule at the anterior superior aspect of the third ventricle.Several punctate foci of T2 and FLAIR signal hyperintensity are present in the thalami, brainstem and basal ganglia.A punctate focus of decreased signal on SWI imaging is present most likely representing an isolated microhemorrhage.The left ICA flow void is partially absent on the left.Normal vascular flow voids are present in the distal 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 demonstrate mucous retention cysts. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is a central disk protrusion associated with ligamentum flavum hypertrophy and effacement of CSF ventral and posterior to the spinal cord. Overall there is mild to moderate spinal stenosis at this level.At C4-5 there is a central disk extrusion associated with ligamentum flavum hypertrophy and effacement of CSF ventral and posterior to the spinal cord. There is mild deformity of the cord at this level. Overall there is moderate spinal stenosis at this level.At C5-6 there is no significant compromise to the spinal canal. There is a disk bulge at this level. There is loss of disk space height at this level. There are end-plate and uncovertebral osteophytes at this level with encroachment of exiting nerve roots bilaterally.At C6-7 there is no significant compromise to the spinal canal .There are end-plate and uncovertebral osteophytes at this level with encroachment of the left exiting nerve roots. There is a disk bulge at this level. At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.Bilateral acute watershed distribution infarctions involving the left hemisphere more than the right primarily involving frontal and parietal lobes with minor involvement of the right temporal lobe and left temporal lobe.2.Colloid cyst has been demonstrated on prior exam.3.Multilevel degenerative changes mainly due to disk disease resulting in moderate stenosis at C4-5 and mild to moderate stenosis at C3-4 and encroachment of exiting nerve roots on the left at C6-7 and bilaterally at C5-64.Small lesions in the thalami, brainstem and basal ganglia are most likely vascular related.5.Findings raise the question of inctracranial left ICA stenosis/occlusion. MRA or CT may be helpful in further evaluating this.