Slurred speech and weakness, evaluate for stroke. The exam is partly motion degraded.MRI BRAIN: There are multiple small areas of diffusion restriction in the left occipital, frontal, parietal, and occipital lobes. There is a moderate amount of subcortical and periventricular white matter T2 hyperintensity. There are punctate foci of encephalomalacia within the bilateral basal ganglia, coronal radiata, and pons. There are also numerous scattered punctate foci of supratentorial and infratentorial susceptibility effect. There is no evidence of intracranial mass. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a right sphenoid retention cyst. The orbits, skull, and scalp soft tissues are grossly unremarkable.MRA NECK: There common origin of innominate and left common carotid arteries. There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, and cervical internal/external carotids. The left vertebral artery is diminutive with multifocal areas of narrowing and loss of contrast opacification along V4. The right vertebral artery is dominant with focal high-grade stenosis at its origin. No evidence of aneurysm, dissection, or vascular malformation is apparent.
1. Multiple small areas of acute to early subacute infarcts involving the left occipital, frontal, parietal, and temporal lobes.2. The left vertebral artery is diminutive with multifocal areas of narrowing, as well as chronic occlusion along V4. The right vertebral artery is dominant with focal high-grade stenosis at its origin.3. No evidence of flow-limiting stenosis involving the carotid arteries.4. Scattered bilateral basal ganglia, corona radiata, and pons lacunar infarcts, as well as non-specific subcortical and periventricular T2 hyperintensity suggestive of chronic small vessel ischemic disease.5. Multiple supratentorial and infratentorial punctate foci of susceptibility effect may represent chronic microhemorrhages, perhaps related to hypertension or amyloid angiopathy, or septic emboli, for example.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.