Diagnosis: Other disturbances of skin sensationClinical question: StrokeSigns and Symptoms: Stroke MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a punctate focus of signal loss present in the right pons on SWI.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 demonstrate a mucous retention cyst in the right maxillary sinus.. 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 small. There is fetal origin of the posterior cerebral arteries present bilaterally. The right P1 segment is fairly large. The left P1 segment is small. The left vertebral artery functionally ends in the left posterior inferior cerebellar artery and is hypoplastic distally. 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 an apparent weblike narrowing at the origin of the left internal carotid artery which is suspected to be artifactual. There is no significant stenosis along the course of the vertebral arteries. The left vertebral artery is smaller than the right vertebral artery. The origins of the vertebral arteries are tortuous.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. There is a levocurvature to the thoracic spine centered at the T12-L1 level and a compensatory dextrocurvature to the upper lumbar spine and upper thoracic spine.. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is facet degeneration in the visualized upper lumbar spine and lower thoracic spine. No spinal stenosis is appreciated.There is retroperitoneal fat that extends into the posterior aspect of the left pleural cavity. To lesser degree the same is true in the posterior aspect of the right lower pleural cavity.A small amount of pleural fluid is present.A small cortical renal cystic lesion is partially included on this exam. It is also identified on the CT from 3/28/2015. Appeared to represent a more complex cyst
1.There is an apparent weblike narrowing at the origin of the left internal carotid artery which is suspected to be artifactual. This can be confirmed by duplex ultrasonography.2.There is retroperitoneal fat which extends into the posterior and inferior aspects of the pleural cavities. This is more prominent on the left compared to the right side.3.There is a scoliotic curvature to the lumbar spine which is centered at the T12-L1 without associated spinal stenosis or neural foraminal encroachment.4.There is no evidence for acute ischemic cerebral infarction.5.There is no evidence for intracranial cerebrovascular occlusive disease.6.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 7.There is a complex cortically based cyst on the right kidney which is about 1 cm in size