72 years Female (DOB:1/2/1944)Reason: stroke evaluation History: dysarthriaPROVIDER/ATTENDING NAME: CHRISTINE A BABCOCK BETTY C SOLIVEN MRI of the brainNo diffusion weighted abnormalities are appreciated.There is an extra-axial mass present along the planum sphenoidale measuring 23 mm in width, 16 mm superior-inferior dimension and 21 mm AP dimension which previously measured similar dimensions.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a focus of encephalomalacia present in the inferior aspect of the left cerebellar hemisphere along the left posterior inferior cerebellar artery territory. The intracranial portion of the left vertebral artery flow-void is absent.Small foci of encephalomalacia are present along the right inferior parietal lobule.Normal vascular flow voids are present in the distal carotid and right vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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.There is redemonstration of a small right calvarial osteoma.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 70% stenosis along the left M1 segment along the midportion of the M1 segment one centimeter proximal to the bifurcation. There is also stenosis at the origin of the superior division of the left middle cerebral artery.There is 50% stenosis present along the distal right M1 segment proximal to the bifurcation of the right middle cerebral artery.There is a high-grade stenosis present at the proximal portion of the left A1 segment.There is a 60% stenosis present in the right P2 PCA segmentThere is a stenosis present along the proximal portion of the superior division of the left middle cerebral arteryNo flow is identified in the distal left vertebral artery.The anterior communicating artery is small. The right posterior communicating artery is not readily identified. There is an infundibulum at the origin of the left posterior communicating 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 an approximately 67% stenosis at the left subclavian artery proximal to the origin of the left vertebral artery On the basis of NASCET criteria there is 80% stenosis at the origin of the right internal carotid artery. There is an approximately 67% stenosis at the origin of the right vertebral artery. There is a high grade stenosis of the origin of the left vertebral artery as well as in the midportion of the left vertebral artery.
1.There is 80% stenosis at the origin of the right internal carotid artery. 2.There is an approximately 67% stenosis at the origin of the right vertebral artery. 3.There is an approximately 67% stenosis at the left subclavian artery proximal to the origin of the left vertebral artery 4.There is a high grade stenosis of the origin of the left vertebral artery associated with tandem stenosis along the midportion of the cervical right vertebral artery and occlusion of the distal left vertebral artery.5.70% stenosis along the left M1 segment proximal to the MCA bifurcation.6.There is 50% stenosis present along the distal right M1 segment proximal to the bifurcation.7.There is a high-grade stenosis present at the proximal portion of the left A1 segment.8.High grade stenosis along the superior division of the left MCA.9.High-grade stenosis along the left A1 segment of the anterior cerebral artery associated with a hypoplastic right A1 segment.10.There is a 60% stenosis present in the right P2 PCA segment11.Stable meningioma along the planum sphenoidale.12.There are small chronic phase foci of infarction along the left cerebellar hemisphere and right parietal lobe13.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 