Essential (primary) hypertension [I10], Reason for Study: ^Reason: R/O ischemic stroke History: left facial weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.Small susceptibility lesion on the left thalamus indicates either mineralization or chronic hemosiderin deposition.Patch bilateral periventricular white matter T2/flair high signal intensity lesions are nonspecific, most likely indicate nonspecific small vessel ischemic disease.Multifocal lacunar infarcts are seen in bilateral thalami and right basal ganglia.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate luminal stenosis (or than 50%) at the right MCA M1 segment and right distal ICA cavernous sinus segment. Otherwise no significant luminal stenosis on the left ICA, bilateral ACA and left MCA. Vertebrobasilar system appears to be normal.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate more than 80% luminal stenosis on the right extracranial internal carotid artery just above the bifurcation.The left carotid bifurcation shows irregularity of the lumen, however, the degree of luminal stenosis is less than 50%.The vertebral artery origins are normal.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Nonspecific small vessel ischemic disease with multifocal lacunar infarcts.3. Intracranial as well as extracranial significant arterial luminal stenosis on the right side craniofacial arterial system. In particular, or than 80% luminal stenosis of the right extracranial proximal internal carotid artery and more than 50% right MCA M1 segment.