50 years Male (DOB:11/5/1965)Reason: evaluate for ischemic infarct History: weakness Dysarthria and anarthriaPROVIDER/ATTENDING NAME: DIANE B CHANEY AGNIESZKA A ARDELT MRI of the brainThere is a punctate focus of diffusion restriction in the right half of the pons which is associated with some vague signal hyperintensity on FLAIR MRI.Small foci of volume loss and signal change are present in the left cerebellar hemisphere inferiorly compatible with encephalomalacia.There is patchy T2 signal hyperintensity in the midbrain associated with a punctate focus of T2 signal hyperintensity. Punctate foci of T2 signal hyperintensity are present in the left thalamus and in the midbrain.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Punctate focus of signal loss on susceptibility imaging is present in the right centrum semiovale. Another focus of punctate signal loss on SWI is present along the posterior aspect of the left pons. Initial location these are of unknown clinical significance. The could be related to hypertension. 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The exam is mildly degraded due to patient motion.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 a high-grade stenosis present along the distal cavernous segment of the right internal carotid artery. The intracranial vasculature appears irregular.There is some mild narrowing of the left internal carotid artery at the clinoid segment.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.Findings are compatible with acute lacunar infarct involving the right pons.2.Punctate lesions in the left thalamus and right midbrain are suspected to represent old lacunar infarcts.3.There is a high-grade stenosis present along the distal cavernous segment of the right internal carotid artery. 4.Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 5.Microhemorrhages are identified in the left thalamus and right centrum semiovale. There is significance is unknown. They could be related to hypertension