Slurred speech [R47.81], Reason for Study: ^Reason: eval for acute infarct, assess lesion burden History: stroke/tia (see MRA order) Brain MRINo evidence of acute ischemic or hemorrhagic lesion on this scan.Multiple scattered high signal intensity lesions on periventricular white matter, centrum semiovale and bilateral external capsule indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal various degree intracranial arterial luminal stenosis including distal right ICA and bilateral MCA M1 and M2 segments indicating atherosclerosis. Some of stenosis degree appear to be more than 50%, however, since the TOF MRA can exaggerate the degree of stenosis, if precise evaluation of the degree of stenosis is necessary, CT angiography can be considered.There is no evidence of intracranial major arterial branch occlusion or intracranial arterial aneurysm on this scan.Bilateral PCAs are fetal origin and Acom artery is patent.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Intracranial atherosclerotic changes of multifocal various degree arterial luminal narrowings as described above. No aneurysm was seen. 