Muscle weakness (generalized) [M62.81] / Cerebral infarction, unspecified [I63.9], Reason for Study: ^Reason: stroke eval History: as above Brain MRIThere is a focal restricted diffusion area on the right periventricular white matter and the right side basal ganglia without evidence of hemorrhagic conversion.Underlying brain shows multifocal small lacunar infarcts in bilateral basal ganglia and thalami, unchanged.Nonspecific small vessel ischemic disease are again seen, unchanged since prior scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage. The midline structures and cranial-cervical junction are normal. 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 multifocal various degree irregularities and narrowings of intracranial vasculature including bilateral PCAs and distal M1 segment of left MCA which appear to have more than 50% of luminal stenosis. Comparing to prior scan, no significant interval change is seen.There is no occlusion of the major intracranial artery. There is no evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate There is less than 20% of luminal stenosis of right proximal internal carotid artery just after the bifurcation. The left common carotid artery and extracranial internal carotid artery appear to be unremarkable. Otherwise no significant arterial luminal stenosis on craniofacial arterial system although it shows tortuosity and ectasia of common carotid arteries and extracranial internal carotid arteries indicate atherosclerotic changes.Left vertebral artery is hypoplastic and appears to be finish with the left PICA.
1. Acute ischemic infarct on the left periventricular white matter and basal ganglia as described above without evidence of hemorrhagic transformation.2. Mild to moderate atherosclerotic changes of intracranial arterial system, unchanged since prior scan.3. Atherosclerotic changes of extracranial craniofacial arterial system, grossly unchanged since prior scan. No significant luminal stenosis (more than 50%). 