Diagnosis: Disorientation, unspecifiedClinical question: strokeSigns and Symptoms: ams MRI of the brainNo diffusion weighted abnormalities are appreciated.The ventricles are large. There is cavum septum pellucidum and cavum vergae.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. 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 small. The posterior communicating arteries are tiny. The left vertebral artery is larger than the right vertebral artery.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.
1.No evidence for acute ischemic cerebral infarction.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related.3.Ventriculomegaly could be a result of atrophy, though NPH/communicating hydrocephalus is associated with ventriculomegaly in the appropriate clinical context.4.No evidence for intracranial cerebrovascular occlusive disease.5.No evidence for extracranial cerebrovascular occlusive disease.