86 years Male (DOB:4/21/1930)Reason: r/o mass lesion History: acute mental status changePROVIDER/ATTENDING NAME: NAOUM ISSA ELBERT S. HUANG Brain MRIThere is restricted diffusion lesion on the left globus pallidus and the genu of left internal capsule with patchy enhancement on post Gadolinium enhancement indicating subacute ischemic infarction with surrounding minimal edema. Punctate susceptibility lesions are seen on bilateral globus pallidi which likely represent parenchymal mineralization. However, the left side globus pallidus shows asymmetrically more prominent susceptibility nodular lesions. Since these susceptibility lesions are overlapping with restricted diffusion lesion, the possibility of focal petechial hemorrhagic lesions cannot be completely excluded. There are multifocal somewhat patchy T2/FLAIR high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. There is no mass, midline shift. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Diffuse segmental narrowing of the distal right vertebral artery is seen with about 30% luminal stenosis likely related to atherosclerotic change, otherwise vertebrobasilar system are unremarkable.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There are about 10% luminal narrowing on the left carotid bulb, otherwise extracranial carotid arterial system appears to be unremarkable. Specifically, there is no evidence of significant luminal stenosis or arterial occlusion.
1. Subacute ischemic infarction involving the left globus pallidus and the genu of left side internal capsule with minimal surrounding edema.2. Asymmetric susceptibility lesions on the left globus pallidus which overlap with restricted diffusion lesion could represent parenchymal mineralization. However, the possibility of focal petechial hemorrhagic conversion cannot be completely excluded.3. Non specific small vessel ischemic disease.4. Atherosclerotic changes of intracranial and extracranial arterial system without evidence of significant (more than 50%) luminal stenosis or evidence of large vessel occlusion. No intracranial arterial aneurysm. 