69 years Female (DOB:10/2/1946)Reason: Stroke work up in setting of new onset seizure History: Shaking of L side and unrespnosive, L gaze deviationPROVIDER/ATTENDING NAME: TAO W XIE TAO W XIE MRI of the brainNo diffusion weighted abnormalities are appreciated.There is encephalomalacia present along the right superior frontal gyrus and right cingulate gyrus. There is some diffusion restriction is present along portions of the right cingulate gyrus and right superior frontal gyrus.In general the brainstem and cerebellum are relatively small. There are some patchy T2 and FLAIR signal hyperintensities within the pons.There are submillimeter punctate foci of T2 and FLAIR signal hyperintensity in the thalami. On susceptibility weighted imaging there are punctate foci of signal hypointensity within the thalami bilaterally which correspond to the T2 and FLAIR signal abnormalities.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.The calcifications present along the falx.MRA brain:The MRA exam is mildly degraded due to motion artifact.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. The right A1 segment is larger than the left A1 segment. The right anterior cerebral artery becomes attenuated at the level of the A2 segment and does not opacify along the A4 and A5 segments.There is no evidence for intracranial aneurysm .The anterior communicating artery is identified and is medium sized. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.There is encephalomalacia present along the medial aspect of the right frontal lobe involving right superior frontal gyrus and right cingulate gyrus which is associated with some foci of diffusion restriction suggesting a superimposed subacute or acute infarct.2.There is attenuation of the right anterior cerebral artery along the right A2 and A3 segments with suspected occlusion more distally.3.Periventricular and subcortical white matter lesions of a mild degree as well as patchy lesions in the pons are nonspecific. At this age they are most likely vascular related. 4.There is atrophy of the pons and cerebellum.5.A couple microhemorrhages in the thalami are present in isolation these are somewhat nonspecific. They could be hypertensive in origin based on location.6.The MR angiogram is somewhat degraded due to some mild motion artifact which may obscure some subtle or small abnormalities .