85 years Female (DOB:1/10/1931)Reason: word finding difficulty and paraphasic errors concerning for L thalamic and/or L frontal lobe involvement History: pls see abovePROVIDER/ATTENDING NAME: GREGG M HELLAND JACQUELINE T BERNARD MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 punctate focus of signal loss centered in the medulla just to the left of midline and posteriorly which measures 3 mm on T2-weighted imaging and has a subtle T2 signal hyperintense component centrally. It cannot be identified on the other pulse sequencesOn susceptibility weighted imaging there is a punctate focus of signal hypointensity present in the left lower midbrain. Another punctate focus identified on susceptibility imaging is present in the posterior aspect of the left orbital gyrusOn susceptibility weighted imaging there is a somewhat ectatic appearing vessel located in the left postcentral gyrus lateral to the hand motor area. It is not included on the MRA exam of the brain.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 fetal origin of the posterior cerebral arteries bilaterally associated with a hypoplastic right P1 segment and a small left P1 segment. There is a small submillimeter sized bump along the left P1 segment which appears to be an infundibulum.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. The left vertebral artery originates from the aortic arch. The left vertebral artery is smaller than the right vertebral artery.
1.There is no evidence for acute ischemic cerebral infarction.2.There is a 3mm hemorrhagic lesion present within the midbrain. Although this could represent a microhemorrhage but also represent a cavernoma.3.There is an incompletely imaged ectatic vessel in the left central sulcus. It is not included on the MRA exams. The possibility of an aneurysm can't be excluded. A CT angiogram of the brain may be of benefit in further evaluating this. Alternatively an MRA exam at 3 Tesla which includes the upper aspect of the brain may be of further benefit in evaluating this. The technologist was asked to recall this patient, specifically for this particular focus, however, because the patient has been discharged home which may present some difficulties in doing so.4.A couple microhemorrhages in isolation are probably of little clinical significance.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 