Clinical question: Extracranial stenoses. Signs and symptoms: Syncope. Nonenhanced brain MRI:No evidence of an acute intracranial process detected.There is a slight prominence of cortical sulci and supratentorial ventricular system for patient's stated age. There is however no detectable signal abnormality of brain parenchymal on any of the MRI sequences.Cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination are unremarkable otherwise.The signal void of major intracranial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable calvarium and soft tissues of the scalp. Unremarkable orbits, paranasal sinuses and mastoid air cells.Nonenhanced brain MRA:Patent bilateral internal carotid arteries across the skull base and there supraclinoid segments. Patent bilateral anterior and middle cerebral arteries and their branches. Patent bilateral vertebral arteries, bilateral pica branches, basilar artery, superior cerebellar and bilateral posterior cerebral. There is a prominent left posterior communicating artery present and read resultant hypoplastic P1 segment of the left posterior cerebral.Enhanced neck MRA: The visualized aortic arch and the origins of the major vessels are unremarkable.Brachial cephalic and bilateral subclavian arteries are unremarkable. Patent bilateral common carotid arteries.Patent bilateral internal carotid arteries. Very minimal shallow atherosclerotic plaque at the origins of bilateral internal carotid arteries without compromise of lumen is noted.Patent bilateral external carotid arteries.Unremarkable left vertebral artery.The origin and the proximal segment of the right vertebral artery is not well visualized likely secondary to severe tortuosity. However possibility of atherosclerotic disease and result in stenosis cannot be entirely excluded. Beyond the very proximal segment the right vertebral artery remains widely patent throughout the neck and across to skull base.
1.Unremarkable nonenhanced brain MRI. Please see above comments.2.Unremarkable nonenhanced brain MRA.3.Unremarkable enhanced MRA of neck. Note should be made that the very origin and proximal right vertebral artery is not well visualized likely secondary to tortuosity.