47 years Male (DOB:7/24/1969)Reason: stroke History: strokePROVIDER/ATTENDING NAME: NAVNEET CHEEMA TAO L XIE MRI of the brainThere are punctate foci of diffusion restriction identified in the left midbrain, the right paramedian vermis the medial aspect of the left cerebellar hemisphere as well as a couple punctate foci of diffusion restriction in the right medial temporal lobe and occipital lobe. There are additional punctate focus of diffusion restriction present along the right paramedian corpus callosum at the anterior aspect of the body of the corpus callosum.The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of cavum septum pellucidum and cavum vergaeThere is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present as well as some patchy lesions in the brainstem which are identified on the FLAIR and T2 images. These were also present on the prior exam and have not changed substantially.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 mild mucosal thickening. 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. The right A1 segment is hypoplastic. There is fetal origin of the right posterior cerebral artery associated with a hypoplastic right P1 segment. The left posterior communicating is a small. The vertebral arteries are similar in size. The left P1 segment and the proximal superior cerebellar arteries are partially obscured by artifact on the time-of-flight MRA of the brain, however, preserved visualized on the contrast-enhanced MRA of the neck.There is extracranial origin of the right posterior inferior cerebellar artery present.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 common carotid artery originates from the innominate artery. The right vertebral artery is slightly larger than the left vertebral artery and
1.Multiple (approximately 5) microinfarcts are present along the posterior circulation with an additional lesion along the right half of the corpus callosum anterior body.2.Although there is no direct evidence for intracranial cerebrovascular occlusive disease the proximal portions of the left posterior cerebral artery and superior cerebellar arteries are obscured by artifact on the time-of-flight MRA, however, on the contrast enhanced MRA of the neck it does not appear that the left posterior cerebral artery has any significant stenosis associated with it.3.Periventricular and subcortical white matter lesions of a mild degree as well as some patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. They are stable relative to the prior exam.