Left-sided numbness. Altered status. BRAIN MRI:The moderate frontoparietal periventricular white-matter hypoattenuation on the CT scan correlates with T2/FLAIR hyperintensity without diffusion restriction. This is most compatible with chronic microvascular ischemia. There is no abnormal brain diffusion restriction or susceptibility effect to suggest acute infarct or hemorrhage, respectively. The brain volume loss is more pronounced in the frontotemporal lobes. There is no mass-effect or midline shift. There is no destructive skull lesion. There is no gross orbital abnormality, accounting for findings of previous bilateral cataract surgery. Left occipital fat intensity lesion is compatible with a lipoma and measures in the axial plane 2.0 cm x 0.6 cm.CRANIAL MRA:There is no significant, flow-limiting stenosis of the major intracranial arteries. Of note, the left vertebral artery is smaller than the right which is probably developmental/congenital. The right posterior cerebral artery is almost fetal-type, which is a normal variation.NECK MRA:There is mild focal narrowing in the distal left common carotid artery, just upstream from its bifurcation which involves the origin of the left external carotid artery without hemodynamically significant stenosis. Otherwise, the cervical carotid arteries show preserved caliber, contrast opacification and flow-related signal.The left vertebral artery is smaller than the right, throughout its length and without ostial narrowing. This is probably congenital/developmental.
1.There is no acute brain ischemia or acute intracranial hemorrhage.2.Moderate cerebral chronic microvascular ischemia is also associated with volume loss that is more pronounced in the frontal and temporal lobes.3.Cranial MR angiography shows no significant stenosis or aneurysm.4.Neck MR angiography shows mild distal left common carotid artery narrowing but no significant, flow-limiting stenosis otherwise. The small size of the left vertebral artery is felt to be congenital/developmental.