Female, 58 years old, with double vision, vertigo, decreased sensation on the left side. A 3 mm focus of restricted diffusion is seen along the left paramedian pontine tegmentum with very mild associated T2 hyperintensity. This lesion produces no mass effect. No other diffusion restricting lesions are identified.Patchy foci of white matter T2 hyperintensity are seen, a nonspecific finding. None of these is associated with significant edema or mass effect. No evidence of acute or chronic intracranial hemorrhage is seen. No abnormal extra-axial fluid collections are detected. Ventricular size and morphology are within normal limits.MRA imaging of the intracranial vessels appears to demonstrate a focal moderate to severe stenosis of the left P1 PCA. No other definite high-grade intracranial vascular stenosis is seen. No aneurysm or vascular malformation is suspected.MRA imaging of the neck demonstrates patency of the great vessel origins. There may be mild atherosclerotic disease at the carotid bifurcations, but no significant stenosis is detected by NASCET criteria. Likewise, the vertebral vessels appear to be free of significant stenosis in the neck.
1.A 3 mm focus of acute ischemia is suspected within the left paramedian pontine tegmentum. No other acute ischemic lesions are seen.2.Evidence of chronic microvascular ischemic disease is noted.3.A moderate focal stenosis is demonstrated at the left P1 PCA. No other significant intracranial vascular abnormality is detected.4.No significant compromise of the vessels of the neck is seen.