Dysarthria and anarthria [R47.1], Reason for Study: ^Reason: stroke workup History: h/o 3 strokes, worsening dysarthria Brain MRIMultiple high signal intensity lesions on DWI are most likely T2 shine through artifacts except one on the right superior parietal lobule (series 506, image 200) which could represent an acute or subacute ischemic lesion.There are multifocal bihemispheric lacunar infarctions. There are patchy FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter indicating non specific small vessel ischemic disease. There are susceptibility lesions on the right occipital lobe and right frontal lobe which are corresponding to FLAIR/T2 high signal intensity indicating chronic ischemic lesion with focal hemorrhagic conversion.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection. 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 multifocal arterial luminal stenosis. In particular, there is about 20-30% luminal stenosis at the mid portion of the right ICA carotid canal (petrous segment), about 80-90% stenosis at the right ICA cavernous sinus segment genu portion, about 70-80% stenosis of left ICA distal carotid canal segment, and about 80% stenosis of the left ICA cavernous sinus segment. Bilateral MCAs and ACAs as well as vertebrobasilar system are unremarkable.
1. Suspicious focal acute or subacute ischemic stroke on the right superior parietal lobule.2. Moderate degree non specific small vessel ischemic disease.3. Multifocal bihemispheric lacunar infarctions.4. Multifocal bilateral distal intracranial ICA luminal stenosis involving petrous segments and cavernous segments with the degree of about 20-30% to 80-90%.