Occlusion and stenosis of carotid artery with cerebral infarction [433.11], Reason for Study: ^Reason: History of stroke with left carotid stenosis for yearly follow up History: History of stroke with left carotid stenosis for yearly follow up. Brain MRI:No evidence of acute ischemic or hemorrhagic lesion.Redemonstration of encephalomalacia in the left frontal lobe, along the left middle frontal gyrus, left occipital lobe, and at the cerebral vertex compatible with chronic infarctions.Multiple scattered high signal intensity lesions in bilateral periventricular white matter and right globus pallidus indicate chronic ischemic lesion. Associated susceptibility artifacts on the right basal ganglia suggest chronic petechial hemorrhage. Above findings do not show any interval change since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. 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 subtle luminal irregularities of basilar artery, right vertebrobasilar junction and distal vertebral artery. There is focal luminal narrowing on the left ICA cavernous segment which appears to be more than 50% stenosis. Above findings suggest intracranial atherosclerosis. Comparing to prior scan, there is no significant interval change. Bilateral PCAs are fetal origin, and bilateral MCAs and ACAs appear to be normal. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate about 35% (based on NASCET method) left extracranial ICA. Comparing to prior scan, there is no significant interval change.Proximal right extracranial ICA shows about 5% stenosis, which again no change since prior exam. The right vertebral artery ostium shows about 50% of luminal stenosis. The left vertebral artery is hypoplastic.
1. No evidence of acute ischemic or hemorrhagic lesion.2. No change of multifocal chronic ischemic lesions.3. Left extracranial ICA stenosis, about 35%, no change since prior scan.4. Right extracranial ICA stenosis, about 5%, no change since prior scan.5. Right vertebral artery ostial stenosis, about 50%, no change since prior scan.