51-year-old male with medical history of ESRD. Presenting with altered mental status. CT of brain without infusion.Heavy vascular calcification of bilateral cavernous carotids are noted. Extensive small vessel disease of undetermined age in the supratentorial brain parenchyma. Old left posterior temporal and parietal cortical stroke with heavy calcification is noted.Images through posterior fossa are suspects of an acute/subacute stroke of the vermis. No hemorrhage is detected. Further evaluation with an MRI is recommended.CTA of cervical region.The right common carotid artery including its origin is unremarkable. No stenosis at the level of the bifurcation of right common carotid artery. Atherosclerotic calcific plaque at the level of the bifurcation and in distal cervical portion of the internal carotid artery is noted however no stenosis is detected.The left common carotid artery including its origin is unremarkable for any stenosis. The bifurcation of the carotid is normal. The left internal carotid artery remains normal. Shallow atherosclerotic calcific plaques in the left common and internal carotid arteries noted with no stenosis.Vertebral arteries are small bilaterally which is believed to be a congenital variation. No evidence of stenosis. Small shallow calcific plaques are identified.CTA of intracranial circulation.CTA of vertebral basilar system demonstrates patent bilateral vertebral arteries across the foramen magnum. Irregularity of the lumen is consistent with atherosclerotic disease with mild stenosis of distal bilateral vertebral arteries. The basilar artery demonstrate atherosclerotic irregularity and some mild stenosis at his distal segment.CTA of the carotid system demonstrate normal appearing bilateral supraclinoid internal carotid arteries with no disease. There is good visualization of bilateral middle and anterior cerebral arteries with no hemodynamically significant stenosis. Prominent bilateral posterior communicating arteries are noted. This can explain the small size of bilateral vertebral arteries.CTV. out intracranial circulation.This examination is within normal limits.
1.No area of significant stenosis in the vasculature of the cervical region including bilateral common carotid, bilateral internal carotids and both vertebral arteries.2.Calcific atherosclerotic plaques however are noted in both vertebral arteries and carotid system.3.No hemodynamically significant stenosis of the carotid systems intracranially.4.Atherosclerotic disease of distal vertebral arteries and basilar artery with mild areas of stenosis in both basilar and vertebral arteries.5.Small bilateral vertebral arteries is believed to be an anatomical variation secondary to presence of prominent bilateral posterior communicating arteries.6.Unremarkable intracranial venous sinuses.7.Advanced to small vessel disease of both hemispheres of undetermined age.8.Old left hemispheric cortical stroke within the calcification.9.Suspected acute/subacute stroke of vermis.10.Follow-up with an MRI is recommended.11.12.