Diagnosis: Unqualified visual loss, right eye, normal vision left eyeClinical question: Evaluate for ischemiaSigns and Symptoms: Sudden loss of vision in R eye MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild 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. There is a punctate focus of signal hypointensity identified in the left frontal lobe subcortical white matter at the left superior frontal gyrus near the superior frontal sulcus. Most likely this represents a microhemorrhage which in isolation is of unknown clinical significance.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 right eye lens is 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.The right ophthalmic artery is attenuated and not readily identified relative to the left ophthalmic artery is readily identified.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.The right ophthalmic artery appears to be attenuated relative to the left ophthalmic artery. This is nonspecific finding and could relate to variant supply to the right orbit though it could also relate to vascular occlusive disease. Please correlate with ophthalmoscopic examination.2.No evidence for intracranial cerebrovascular occlusive disease.3.There is no evidence for acute cerebral ischemic infarction4.No evidence for intracranial aneurysm.5.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 