75 years Female (DOB:9/28/1940)Reason: evaluate for ischemia History: vertigo + nystagmusPROVIDER/ATTENDING NAME: RIMAS V. LUKAS RIMAS V. LUKAS MRI of the brainNo diffusion weighted abnormalities are appreciated.A punctate focus of signal loss and susceptibility imaging is present in the left centrum semiovale. In isolation this is of unknown clinical significance. It most likely represents a microhemorrhage.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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.Incidental note is made of partial empty sella.Exam is mildly degraded by patient motion.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 right A1 segment is hypoplastic. The dominant supply to both anterior cerebral arteries at the A2 segments appears to be from the left side. The posterior communicating are very small. The left vertebral artery is very small.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 right vertebral artery. The left vertebral artery is very small. There is a suspected stenosis at the origin of the left vertebral artery but the left vertebral artery is too small to characterize the stenosis on this exam.
1.No evidence for intracranial aneurysm.2.No evidence for any significant intracranial or extracranial cervicocerebral vascular occlusive disease. The left vertebral artery is very small and it is not clear if there is a significant stenosis present proximally at its origin3.There is no evidence for acute ischemic cerebral infarction.4.Examination is mildly degraded due to patient motion which may obscure more subtle abnormalities.