45 years Female (DOB:11/1/1970)Reason: Evaluate for follow up neuroimaging as part of stroke workup - L M1 stenosis noted on CTA History: R hemiplegia, global aphasiaPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainThere are patchy foci of diffusion restriction in the left middle cerebral artery territory particularly in the watershed zones involved areas include the left caudate nucleus left middle frontal gyrus, left pre and postcentral gyri and portions of the left superior parietal lobule and portions of the left inferior parietal lobule. These are associated with FLAIR signal hyperintensity. There is intravascular enhancement and some leptomeningeal enhancement along the left middle cerebral artery territory suggestive of early subacute phase infarction.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. T2 and FLAIR hyperintense patchy lesions are present in the brainstem.There are multiple punctate foci of signal hypointensity present in the brainstem, thalami and basal ganglia as well as the right insular cortex and right frontal lobe. There are foci of signal loss within the patchy areas in the inferior infarction in the left frontal and parietal lobes.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 are clear. 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 a high-grade 90% stenosis present proximal left middle cerebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.There is a high-grade stenosis present at the proximal left middle cerebral artery M1 segment. It is not clear whether this is related to acute thrombus or stenosis due to other cause.2.There are patchy foci of subacute infarction the left middle cerebral artery territory some of which display some petechial blood.3.There are multiple microhemorrhages predominantly in the distribution suggestive of hypertension.4.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific, however, given the patient's other findings most likely they are vascular related.5.Patchy lesions in the brainstem are likely vascular related as well.