Diagnosis: Anesthesia of skinClinical question: stroke? TIA?Signs and Symptoms: r arm weakness MRI of the brainThere are several punctate foci of diffusion restriction present in the cortex of the right parietal lobe at the medial aspect of the right post-central gyrus, the right middle frontal gyrus, right posterior temporal lobe and the medial right parietal lobe.There is a punctate focus of susceptibility at the right middle frontal gyrus.There is a focus of T2 and FLAIR associated with volume loss located at the right cerebellar peduncle.The CSF spaces are appropriate for the patient's stated age with no midline shift. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the right mastoid air cells. The visualized portions of the orbits are intact.MRA brain: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. There is fetal origin of the left posterior cerebral artery present. The right posterior communicating artery is medium-sized. The right P1 segment is similar in diameter to the right posterior communicating artery. The left P1 segment is hypoplastic.The anterior communicating artery is identified and is medium size. The left A1 segment is asymmetrically small. The vertebral arteries are asymmetric. The left vertebral artery is larger than the right vertebral artery.There is approximately 40% narrowing at the origin of the right middle cerebral artery and tandem 40% stenosis along the proximal portion of the superior division of the right middle cerebral artery..MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. There is mild narrowing at the origin of the left subclavian artery. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is irregular plaque present along the right carotid bifurcation associated with mild narrowing of the proximal right internal carotid artery. There is approximately 40% narrowing at the origin of the right internal carotid artery. There is approximately 30% narrowing at the origin of the left internal carotid artery. The vertebral arteries are irregular bilaterally with tortuous origins bilaterally. There appears to be a stenosis at the origin of the right vertebral artery and the right vertebral artery is irregular in diameter throughout its course
1.There are multiple foci of acute/subacute microinfarction along the right hemisphere. These include the right post central gyrus, right medial parietal lobe, right posterior temporal lobe and right middle frontal gyrus.2.There is a small focus of encephalomalacia along the right cerebellar hemisphere.3.There is a microhemorrhage along the right middle frontal gyrus. In isolation this is of little clinical significance.4.There is irregular plaque present at the origin of the right internal carotid artery. There is no significant stenosis at the origins of the internal carotid arteries on the basis of NASCET criteria.5.The right vertebral artery appears to be stenotic proximally and has multiple foci of irregular stenosis throughout its course in the neck..6.There is approximately 40% narrowing at the origin of the right middle cerebral artery and tandem 40% stenosis along the proximal portion of the superior division of the right middle cerebral artery.