Female, 65 years old, past medical history of HTN, DM (not on insulin), CAD s/p PCI (3 stents 11/2013) on clopidogrel, CHF. Presented to ED with right upper extremity weakness. Brain MRI:The hemorrhage in the posterior left inferior temporal gyrus is now a linear, hemosiderin stained tract without surrounding edema. Other small foci of susceptibility effect present throughout the brain (including the left supramarginal gyrus and in the left thalamus) are not significantly changed. There is no new foci of intracranial hemorrhage. There are multifocal frontal-parietal white matter and deep gray T2 hyperintense lesions as well as more ill defined chronic microvascular ischemia which are not significantly changed compared to the previous examination. There is no mass effect or midline shift. There is minimal ethmoidal mucosal thickening without fluid. The paranasal sinuses are clear as well as the mastoid air cells. The orbits are unremarkable.Head MR Angiography:The intracranial internal carotid arteries show normal, symmetric flow-related contrast enhancement and caliber. Similarly, the paired anterior and middle cerebral arteries are unremarkable. The intracranial vertebral arteries, the basilar artery and posterior cerebral arteries are also unremarkable. There are no or very small posterior communicating arteries. There is no aneurysm.Neck MR Angiography:The left common carotid artery shares the same origin as the right brachiocephalic artery. The aortic arch and great vessels are tortuous and mildly ectatic. There is no significant ostial narrowing at the aortic arch level. There is mild narrowings at the left and the right carotid bifurcations. There is no significant cervical carotid narrowing otherwise. The vertebral arteries conventionally arise from their respective subclavian arteries. There is mild narrowing of the lower segment of the right vertebral artery. Otherwise, there is new significant vertebral artery luminal narrowing.
1.Cerebral white matter lesions perhaps representing chronic microvascular ischemia and lacunar infarcts are not significantly change since the previous MRI from March 2015. A parenchymal hematoma in the left temporal lobe shows expected evolution no appearing chronic and essentially resolved. There is no new intracranial hemorrhage.2.Head and neck MR angiography shows no significant vessel stenosis or occlusion. There is mild narrowing at the carotid bifurcations and proximal right V1 segment.