Diagnosis: Cerebral infarction, unspecifiedClinical question: stroke r/o MRI of the brainThere are several punctate foci of diffusion restriction present in the right precentral gyrus which are associated with some leptomeningeal and intraparenchymal contrast enhancement.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are punctate T2 and FLAIR hyperintense lesion present in the brainstem.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 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 left vertebral artery is larger than the right vertebral artery. 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 irregular plaque present along the right carotid bifurcation. The origins of the vertebral arteries are tortuous and not well evaluated. No stenosis identified in the vertebral arteries distal to their origins. There is no convincing evidence for stenosis at the vertebral artery origins.
1.Findings are compatible with microinfarcts in the right precentral gyrus which are in the acute/ early subacute phase.2.There is no evidence for intracranial or extracranial cerebrovascular stenosis. The origins of the vertebral arteries are not well evaluated on this exam.3.Irregular plaque is present at the right carotid bifurcation.