82 years Female (DOB:11/28/1933)Reason: assess for aneurysm History: thalamic bleedPROVIDER/ATTENDING NAME: AGNIESZKA A ARDELT RAYMOND A ROOS MRI of the brainNo diffusion weighted abnormalities are appreciated.. Patchy T2 and FLAIR hyperintense foci are present in the thalami and basal ganglia as well as the brainstem.On susceptibility imaging there are multiple small foci of signal loss present in the thalami to a lesser degree basal ganglia and internal capsules and in the upper brainstem as well as some of the subcortical white matter in the frontal, parietal and temporal lobes and also scattered in the cerebellar hemispheres.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 cyst in the left maxillary sinus.. 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. There is extracranial origin of the left posterior inferior cerebellar artery. There is triplication of the anterior cerebral artery. Anterior communicating artery appears to be incompletely. The posterior communicating arteries are not readily appreciated. The left vertebral artery slightly smaller than the right vertebral artery.
1.No evidence for cerebrovascular occlusive disease.2.There is no evidence for acute ischemic cerebral infarction.3.There are multiple microhemorrhages scattered throughout the brain parenchyma a somewhat favor thalami and internal capsules and upper brainstem but are present throughout the cerebellum and to lesser subcortical white matter. This pattern is suggestive of hypertensive microhemorrhages however superimposed process may be present.4.Patchy lesions in the brainstem and thalami basal ganglia are likely vascular related at this age.5.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 