Diagnosis: Altered mental statusClinical question: strokeSigns and Symptoms: stroke MRI of the brainThere are multiple foci of diffusion restriction present. As a patchy areas of diffusion restriction involving the cerebellar hemispheres bilaterally. The area involved in the right cerebellar hemisphere measures approximately 44 x 36 mm axial dimensions. The area involving the left cerebellar hemisphere measures 25 x 38 mm in axial dimensions. There are punctate foci of diffusion restriction scattered in the subcortical and periventricular white matter of the supratentorial brain and all lobes. The periventricular lesions appear to be somewhat larger. Additionally there are small foci of diffusion restriction present in the basal ganglia bilaterally. On susceptibility imaging there is signal loss present in the cerebellar hemispheres bilaterally and relatively small regions suggesting either petechial blood or small foci of hemorrhagic conversion.The CSF spaces are appropriate for the patient's stated age with no midline shift. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and 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.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is triplication of the anterior cerebral artery. The one segments are similar in size. The left posterior communicating artery is medium-sized. The right posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.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. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is mild reversal of the normal cervical curvature presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.No evidence for intracranial aneurysm.2.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.3.Multiple foci of infarction are present in the periventricular white matter, subcortical white matter, basal ganglia and cerebellar hemispheres. There is a small amount blood associated with the cerebellar lesions which are somewhat larger.4.Findings were discussed with Dr Kramer at the time of the exam.5.There is no compromise cervical spinal canal or exiting nerve roots. There is mild reversal of normal cervical curvature which could be related to patient positioning or muscle spasm.