Clinical question: Evaluate for atherosclerotic disease, ischemia. Signs and symptoms: Unresponsive, impaired speech and dysarthria. Nonenhanced brain MRA:Bilateral vertebral arteries are widely patent and unremarkable. The left pica and right aica/pica common trunk is identified. Basilar artery and its distal branches are widely patent. Bilateral posterior posterior cerebral arteries demonstrate diffuse irregularity of the lumen with multiple foci of moderate to high-grade stenosis highly suggestive of atherosclerotic disease. No distal vascular occlusion.Bilateral internal carotid arteries are widely patent across the skull base and in their supraclinoid segments.Bilateral anterior and middle cerebral arteries are well visualized. The knees complete occlusion of the anterior division of left MCA. Examination additionally demonstrate diffuse atherosclerotic irregularity of the vascular lumen bilateral anterior and middle cerebral arteries with multiple foci are mild to moderate degree of the stenosis. This finding in particular is significant in the A2 segment of right anterior cerebral artery which demonstrate high grade stenosis in its pericallosal segment.
1.Extensive intracranial atherosclerotic disease.2.Complete occlusion of left MCA proximal trunk at the bifurcation.3.Significant stenosis of the left pericallosal anterior cerebral artery.4.Patent bilateral vertebral arteries, basilar artery and internal carotid arteries.