Clinical question: Rule out stroke. Structural lesions. Signs and symptoms: Memory issues, dizziness. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates minimal nonspecific foci of flair hyperintensity only in the subcortical and periventricular white matter bilateral cerebral hemispheres. Although nonspecific considering patient's stated age of 75 this appearance likely representing chronic small vessel ischemic strokes of mild degree. There is no significant change of this finding when compared with prior MRI exam from Morris Hospital dated 2 -- 6 -- 14.There is a slight generalized prominence of cerebral cortical sulci which although could be within upper limits of normal for patient's stated age of 75 mild underlying parenchymal bladder loss cannot be entirely excluded. This appearance is also stable since prior MRI exam. Ventricular system remains within normal size and maintained midline and without change since prior exam.Signal voids of major intracranial branches are identified and unremarkable.Unremarkable calvarium, soft tissues of the scalp, paranasal sinuses, mastoid air cells and orbits.Post enhanced images fail to demonstrate any abnormal enhancement of the brain parenchyma, leptomeninges, calvarium or the orbits. There is normal signal intensity of intracranial venous sinuses with normal pattern of enhancement.Nonenhanced brain MRA:Patent and unremarkable bilateral intracranial vertebral arteries, basilar artery and its branchespatent and unremarkable bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries. There is suggestion atherosclerotic disease of distal MCA branches in particular on the right with regions of mild sternum and compromise and without detectable distal vascular occlusion.
1.Pre-and post enhanced brain MRI demonstrate acute intracranial process. Findings suspicious for minimal chronic nonhemorrhagic small vessel ischemic strokes as detailed. Mild generalized prominence of cortical sulci may be at the upper limits of normal for age however mild underlying volume loss cannot be entirely excluded. There is no significant change of the findings since prior MRI exam from 2 -- 6 -- 14.2.Nonenhanced brain MRA demonstrate patent all major intracranial arteries. There is evidence of atherosclerotic disease more noticeably of the distal right MCA branches with resultant mild vascular lumen compromise and no vascular occlusion. 