62 years Male (DOB:9/10/1953)Reason: assess for stroke, mass, and/or seizure focus History: AMSPROVIDER/ATTENDING NAME: KATIE TATARIS JAMES A MASTRIANNI MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is not unusual at this age.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 a mucous retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sellaMRA 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 in size. There is fetal origin of the posterior cerebral arteries bilaterally. The right vertebral artery ends in the right posterior inferior cerebellar artery. The right posterior inferior cerebellar artery has an extracranial origin.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 left vertebral artery. The left vertebral artery origin is tortuous. The right vertebral artery is small and appears narrowed at its origin.
1.There is no evidence for intracranial cerebrovascular occlusive disease.2.There is narrowing at the origin of the right vertebral artery which is relatively small and dominant and supplies the right posterior inferior cerebellar artery.3.There is no evidence for acute ischemic cerebral infarction.