Weakness [R53.1], Reason for Study: ^Reason: stroke eval History: as above Brain MRIThere are gyriform restricted diffusion involving right precentral and postcentral gyri indicating acute ischemic infarct without evidence of hemorrhagic transformation.Underlying brain shows multifocal encephalomalacia involving bilateral basal ganglia, caudate nucleus and bilateral thalami indicating prior ischemic infarct.Scattered bihemispheric FLAIR/T2 high signal intensity lesions involving periventricular white matter and centrum semiovale indicate underlying nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRAMotion artifact degraded exam quality.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate there is a focal signal loss at the junction of right MCA M1 and M2 segment. However, due to patient's significant motion artifact, this signal loss could be an artifact, therefore, if clinically indicated, CT angiography can be considered for further imaging evaluation.Left MCA mid M1 segment 2 the distal M1 segment shows gradual narrowing of the lumen which could indicate atherosclerotic changes. However can't, this finding could also be an artifact.Right ACA A1 segment appears to be hypoplastic.About 20% of luminal stenosis of distal left vertebral artery just before the vertebrobasilar junction. Otherwise posterior circulation appear to be normal.
1. Right precentral and postcentral gyri acute ischemic infarction without evidence of hemorrhagic transformation.2. Right MCA distal M1 segment signal loss may indicate severe luminal stenosis or intraluminal thrombus. However, possibility of artifactual lesion cannot be excluded. In addition, there is gradual tapering of the left MCA M1 segment lumen which may indicate atherosclerotic changes, however, this lesion could also be related to motion artifacts. Therefore, head and neck CT angiography is recommended for further imaging evaluation of vascular structures. 3. Underlying brain shows multifocal chronic ischemic infarctions with encephalomalacia4. Non specific small vessel ischemic disease.