Reason: evaluate for ischemia, stroke History: left leg weakness, lethargy MRI of the brainThe CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stableThere is phase encoding artifact present anteriorly which partially obscures visualization at the anterior skull base.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 convincing evidence for intracranial aneurysm or cerebrovascular occlusion, however, artifacts at the level of the carotid siphons and the proximal ACAs may obscure a subtle lesion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. The left A1 segment is hypoplastic. There is fenestration of the basilar artery .Along the right in the right and left carotid siphon there is artifact present which may obscure a lesion.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.No lesions explaining patient's left-sided leg weakness can be identified.2.Please note that the patient's MR angiogram of the brain is somewhat compromised by artifact especially along the carotid siphon and the A1 and anterior communicating regions. If there is concern for aneurysms, vascular leisons or vascular occlusive lesions in these locations a CT angiogram is suggested or alternatively a 3 Tesla MR angiogram of the brain.