Diagnosis: Facial weaknessClinical question: strokeSigns and Symptoms: R facial droop 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 moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There is a mild degree of punctate lesions in the brainstem which are hyperintense on FLAIR and T2 imaging there are additional T2 hyperintense and FLAIR hyperintense lesions present in the right basal ganglia and internal capsule as well as the left internal capsule.No abnormal mass lesions are appreciated intracranially. 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 demonstrate mucous retention cysts in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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 small. The A1 segments are asymmetric. The right A1 segment is larger than the left A1 segment. There is fetal origin of the right posterior cerebral artery with a medium sized right P1 segment. The left posterior communicating artery is tiny. The left vertebral artery ends in the left posterior inferior cerebellar artery. The right vertebral artery mildly narrows as it enters the subarachnoid space.
1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter lesions a moderate degree as well as a mild degree of the punctate lesions in the brainstem and right basal ganglia and internal capsules are nonspecific. At this age they are most likely vascular related. 3.No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.