Occlusion and stenosis of unspecified carotid artery [I65.29], Reason for Study: ^Reason: 3 t scanner stoke History: ha Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is a chronic ischemic infarct with encephalomalacia involving left frontal operculum, in particular left inferior frontal gyrus associated with ex focal changes of left lateral ventricle frontal horn. A couple of scattered FLAIR/T2 high signal intensities on the left frontal lobe white matter are likely represent associated small chronic ischemic infarcts. Subtle susceptibility lesions within encephalomalacia indicate focal hemorrhagic conversion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The mastoid air cells are clear. Mucosal thickening and retention cyst is seen on the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate nonvisualization of distal left internal carotid artery. Prominent left P-comm artery appears to supply left anterior circulation. However, left MCA and distal MCA branches are diminutive.Right ICA, ACA, and MCA appear to be normal.Left the distal vertebral artery beyond the level of left PICA appears to be hypoplastic. Otherwise, vertebrobasilar system is unremarkable.. Bilateral P-comm as well as a common artery are patent. There is no evidence of intracranial aneurysm. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate left extracranial internal carotid artery just above the bifurcation is not visualized.Right carotid bulb appears to be irregular however, there is no evidence of significant (more than 50%) luminal stenosis.Right vertebral skin appears to be normal.Left vertebral ostium shows about 20-30% of luminal stenosis.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Chronic ischemic infarct with encephalomalacia involving left frontal lobe inferior frontal gyrus.3. Nonvisualization of the left internal carotid artery with reconstitution of left MCA fire left posterior communicating artery.4. Nonvisualization of left extracranial internal carotid artery just above the bifurcation of the left common carotid artery.