Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: r/o stroke History: slurred speech Brain MRIThere is no evidence of acute ischemic lesion on this scan.Susceptibility lesions are seen on the right inferior parietal lobule and right middle frontal gyrus with associated encephalomalacia indicating chronic infarction with hemorrhagic transformations.Gliotic changes are seen at right frontal, parietal and occipital lobes.Patchy FLAIR/T2 high signal intensity lesions are seen on bilateral periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear. Opacifications of the left mastoid air cell are seen. Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate more than 50% of luminal stenosis at the mid to distal left MCA M1 segment. In addition, there are multifocal tandem intracranial luminal stenosis involving right MCA distal, right PCA, left vertebrobasilar junction as well as basilar artery indicating intracranial atherosclerosis.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate segmental signal loss at the right extracranial ICA just above the bifurcation. The signal loss length is measured about 36.4mm. This finding is consistent with post carotid artery stenting, clinical correlation is recommended. Otherwise, right brachiocephalic, left common carotid, and left subclavian arteries do not show any evidence of luminal stenosis. The vertebral artery origins are normal.
1. No evidence of acute ischemic or hemorrhagic lesion.2. More than 50% luminal stenosis of the right MCA M1 segment.3. About 36.4mm length signal loss on the right extracranial ICA on Neck MRA likely representing post carotid stenting status. Otherwise unremarkable. 