90 years Male (DOB:12/14/1925)Reason: eval for tia/stroke History: left facial droopPROVIDER/ATTENDING NAME: DAVID HOWES KEEGAN CHECKETT 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 is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Some patchy T2 and FLAIR signal hyperintense lesions are present in the brainstem.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 an opacity in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right A1 segment is larger than the left A1 segment. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is mild narrowing of the proximal basilar arteryMRA 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 vertebral arteries.
1.There is no evidence for acute cerebral ischemic infarction.2.No evidence for significant intracranial cerebrovascular occlusive disease3.There is no evidence for extracranial cerebrovascular occlusive disease4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.5.Patchy lesions in the brainstem are likely vascular related as well and most likely chronic in nature.