86-year-old female with acute onset of dizziness. Concern for posterior circulation stroke. MRI Brain: There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. There is no diffusion abnormality. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense lesions are appreciated in the brainstem and thalami.A punctate lesion in the left centrum semiovale which is low signal on susceptibility weighted imaging most likely represents a microhemorrhage which in isolation is of little clinical significance.There is a small T2 and FLAIR hyperintense focus along the right postcentral gyrus along its more medial aspect of her presenting an old tiny vascular infarct.Normal flow-voids are demonstrated in the major intracranial vascular structures.There is mild thickening of the right nasal turbinates. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.MRA Neck: The carotid syphons are fusiformly dilated bilaterally. The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The right vertebral artery is somewhat narrowed relative to the left but this may be congenital and there is no evidence of flow-limiting stenosis. The basilar artery and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.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. The distal internal carotid arteries are very patulous measuring up to 7 mm in diameter along the carotid siphon. There is fetal origin of the right posterior cerebral artery with a small right P1 segment. The right vertebral artery is larger than the left vertebral artery.There is no evidence for intracranial aneurysm or cerebrovascular occlusion. Some of the intracranial vasculature is irregular but not significantly narrowed.The anterior communicating artery is identified and is medium size. The left posterior communicating artery is intact.
1.No evidence of acute ischemic or hemorrhagic infarction is appreciated.2.No evidence of flow-limiting stenosis or aneurysm of the vasculature of the head and neck is appreciated. There is some vascular ectasia present intracranially along the anterior circulation.3.Periventricular and subcortical white matter lesions as well as patchy lesions in the brainstem of a mild to moderate degree are nonspecific. At this age they are most likely vascular related. 