75 years Female (DOB:7/7/1941)Reason: evaluate for ischemic changes History: altered mental status, fall at home, CVA hxPROVIDER/ATTENDING NAME: ROBERT M. SARGIS MRI of the brainThere are multiple foci of diffusion restriction present. One in the right centrum semiovale and basal ganglia measures 18 x 11 mm axial dimensions. There are number of smaller foci of diffusion restriction scattered in the left basal ganglia, subcortical white matter of the frontal lobes bilaterally and subcortical white matter of the right parietal lobe.On susceptibility imaging there is a focus of signal loss present within the right lower midbrain and upper pons.A focus of encephalomalacia is present along the left inferior parietal lobule which extends to the adjacent left temporal lobe. This demonstrated diffusion restriction on 12/23/2012.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional punctate foci of hyperintensity on T2 and FLAIR imaging are present in the brainstem. These findings have progressed since the 12/23/2012 examNo 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.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 more distal vasculature and a smaller vasculature is not well evaluated due to signal abnormalities.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the right posterior cerebral artery with a small medium sized right P1 segment. The left P1 segment is slightly larger than the left posterior communicating artery. The vertebral arteries are similar in size. There is extracranial origin the left posterior inferior cerebellar artery .
1.There are multiple small foci of diffusion restriction scattered in both frontal and parietal lobes as well as basal ganglia and centrum semiovale. The largest one is in the right centrum semiovale and basal ganglia. These are compatible with subacute foci of infarction2.A focus of encephalomalacia in the left parietal lobe is present which most likely represents a prior focus of cerebral infarction. This appears to have been in the acute phase December 2012.3.Findings are compatible with a chronic stage small hemorrhage in the right lower midbrain and upper pons.4.Periventricular and subcortical white matter lesions of a mild to moderate degree and punctate lesions in the brainstem are nonspecific. At this age they are most likely vascular related. This has progressed since the 12/23/2012 exam.5.There is no evidence for intracranial cerebrovascular occlusive disease. More distally cerebrovascular occlusive disease may be less obvious on this exam due to lower signal compared to 3 Tesla MR angiography.