 MRI Brain:There are multiple areas of restricted diffusion bilaterally within the cerebral hemispheres including involving the bilateral frontal and bilateral parietal lobes. There is an additional punctate focus of restricted diffusion involving the left cerebellar hemisphere which is also suspicious for an acute infarct. There is a small amount of FLAIR signal abnormality involving a subset of the areas of infarct bilaterally but there is no significant mass effect, midline shift or herniation. There are tiny foci of susceptibility abnormality within the regions of infarct within the bilateral frontal lobes which could indicate chronic microinfarcts. However focal small amount of hemorrhagic conversion cannot be excluded. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: Exam is limited by motion artifact. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The left vertebral artery is asymmetrically smaller compared to the dominant right vertebral artery and appears to terminate in the left PICA. The basilar artery and posterior cerebral arteries also are patent with no significant stenosis. There are prominent posterior communicating arteries bilaterally, a small left P1 segment and absent right P1 segments which are normal variants. No evidence of aneurysms or vascular malformations. MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. The right vertebral artery origin is patent. Artifact limits evaluation of the origin of the left vertebral artery.
1.Multifocal acute infarcts involving the bilateral cerebral hemispheres as well as a punctate infarct involving the left cerebellar hemisphere. No significant mass effect, midline shift or herniation.2.Tiny foci of susceptibility abnormality within the regions of infarct within the bilateral frontal lobes could indicate chronic microinfarcts. However focal small amount of hemorrhagic conversion cannot be excluded. 3.No evidence of significant arterial luminal stenosis or irregularity on both intracranial and extracranial arterial system.4.The left vertebral artery is hypoplastic which ends with left PICA. No intracranial aneurysm is seen.