Unspecified cerebral artery occlusion with cerebral infarctionDiagnosis: Other malaise and fatigueClinical question: r/o acute processSigns and Symptoms: weakness MRI of the brainThere is diffusion restriction along the right MCA territory predominantly involving patchy areas along the right inferior and middle frontal gyri as well as the insular cortex. There are small foci of diffusion restriction along the right temporal lobe.There is subtle FLAIR signal hyperintensity in these areas of diffusion restriction.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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, left middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The right MCA flow voids are not readily recognized.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 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, left middle and posterior cerebral arteries. There is a high grade stenosis at the distal right m1 segment involving superior and inferior divisions.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. There is fetal origin of the PCA bilaterally with a tiny right p1 segment and a small left p1 segment. The LVA is larger than the RVA.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 vertebral arteries. The origins of the vertebral arteries are tortuous.
1.Near complete occlusion of the right m1 segment of the MCA at the bifurcation and distal m1 segment with evidence for slow antegrade flow "outline sign" at the proximal right superior and inferior divisions.2.Acute cerebral infarction involving predominantly the right middle and inferior frontal gyri as well as the right insular cortex with associated smaller foci of infarction in the right temporal lobe.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.No evidence for stenosis at the carotid bifurcation.