acute ataxiamalaise and fatigueClinical question: strokeSquamous cell skin cancerHypertensionOpen wound of chest (wall), without mention of complicationAbdominal aneurysm without mention of rupture MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a punctate lesion in the pons and one in the left thalamus which are high signal on the T2 and the FLAIR MRI sequences.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate focus of susceptibility effect in the right half of the pons.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.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 posterior communicating arteries are intact. The vertebral arteries are similar in size.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. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.Periventricular and subcortical white matter changes of a mild to moderate degree and a small pontine lesion are nonspecific. At this age they are most likely vascular related. 2.An isolated old microhemorrhage in the right half of the pons is nonspecific.3.There is no evidence for intracranial aneurysm.4.No evidence for extracranial cerebrovascular occlusive disease5.No evidence for intracranial cerebrovascular occlusive disease