 Brain MRI:There is a small focus of restricted diffusion with matching ADC hypointensity within the left centrum semiovale consistent with small vessel acute to subacute infarction. It demonstrates T2 hyperintensity, mild T1 hypointensity, and no susceptibility hypointensity.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Scattered foci of mucosal thickening can be found within the paranasal sinuses without air-fluid levels. The mastoid air cells are clear. Brain MRA: Images are motion degraded. Given this caveat:There is a small 2-3 mm aneurysm at the junction of the left A1/A2 ACA segments with the anterior communicating artery. There is antegrade flow within the distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries without occlusion. The distal right vertebral artery appears to end in PICA and is diminutive (please see MRA neck discussion below). Artifact is noted through the mid basilar artery which is otherwise intact with antegrade flow. Intact antegrade flow is also noted within bilateral PCA vessels.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels. There are no significant stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. The right vertebral artery is diminutive in its entirety and appears to end in PICA. However, significant stenosis appears to involve the left vertebral artery origin, and there is irregularity of the lumen at several locations throughout its length, suggesting there may have been previous dissection. Mild stenosis is noted at the origin of the left vertebral artery which is otherwise unremarkable.
1.There is a small focus of restricted diffusion with matching ADC hypointensity within the left centrum semiovale consistent with small vessel acute to subacute infarction.2.There is a small 2-3 mm aneurysm at the junction of the left A1/A2 ACA segments with the anterior communicating artery. 3.The right vertebral artery is diminutive in its entirety and appears to end in PICA. However, significant stenosis appears to involve the left vertebral artery origin, and there is irregularity of the lumen at several locations throughout its length, suggesting there may have been previous dissection. 4.Mild stenosis is noted at the origin of the left vertebral artery which is otherwise unremarkable.