Reason: r/o stenosis or occlusion History: transient right sided weakness MRI of the brainNo diffusion weighted abnormalities are appreciated.T2 and flair MR images demonstrate high signal foci in the brainstem associated with some loss of volume of the brainstem. There is interval appearance of focal signal hyperintensity in the left medulla which was not present on the prior exam.There is a moderate degree of periventricular and subcortical predominantly confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Susceptibility images there the grated by patient motion. There is a gyral signal loss from susceptibility in a small focus of encephalomalacia located in the left middle frontal gyrus anteriorly this was also present on the prior examThe CSF spaces are appropriate for the patient's stated age with no midline shift. 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 demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain: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.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 larger than the right A1 segment. The right posterior communicating artery is not readily identified. The left posterior cerebral artery has fetal origin. The left P1 segment is a very small. There is narrowing of the left posterior cerebral artery in the P2 segment compared to the also appears to be some mild narrowing at the right A3 segment. The vertebral arteries are similar in size.MRA neck:The proximal portions of the great vessels from the aortic arch are not adequately opacified. There is no gross evidence for stenosis at the origins of the great vessels from the aortic arch. There is antegrade flow present along the carotid and vertebral arteries in the neck . On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the visualized course of the vertebral arteries. The origins of the vertebral arteries do not appear to be stenotic but are not well imaged
1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusion or high-grade stenosis. Some of the peripheral vasculature intracranially appears narrowed.3.There is no evidence for acute ischemic infarction appreciated.4.Signal changes are present in the brain stem and is suspected to be vascular related.5.Small focus of encephalomalacia is present in the left frontal lobe which is most likely vascular related. It is stable compared to the prior exam.6.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 