Clinical question: Evaluate for stenosis/occlusive disease, etiology right MCA stroke. Signs and symptoms: Left hand weakness of two days duration. Nonenhanced brain MRA:Bilateral vertebral arteries remain patent across the skull base and in the intracranial segments. Bilateral pica branches are identified.Vascular artery and bilateral superior cerebellar and posterior cerebral arteries are visualized.There is no evidence of high-grade vascular lumen compromise or stenosis however mild atherosclerotic disease of intracranial circulation is suspected.Right internal carotid artery is patent in its distal cervical, across the skull base and in its supraclinoid segment. There is atherosclerotic disease and irregularity of the cavernous carotid on the right with a tiny segmental focus of moderate posterior lumen compromise. The right anterior and middle cerebral arteries are patent. Regions of vascular lumen irregularity and moderate stenosis are noted in the anterior division of right MCA distal branches.The internal prior arteries is patent and is visualized cervical segment and across the skull base as well as its supraclinoid segment. Mild atherosclerotic disease of the cavernous carotid with resultant mild to moderate vascular lumen compromise is present.Right anterior cerebral artery demonstrate mild atherosclerotic plaque at its origin and patent otherwise. There is a short segment of absence of visualization of the proximal M2 segment of left middle cerebral artery suggestive of high-grade stenosis. Possibly two complete occlusion cannot be entirely excluded. Branches of left MCA however beyond this focus remains been visualized and with similar signal pattern and is the opposite side suggesting likelihood of antegrade filling. Mild atherosclerotic irregularity and stenosis of the proximal M1 segment of the left middle cerebral arteries also noted.
1.Patent bilateral vertebral arteries, basilar artery and their branches however within the distal atherosclerotic vascular inlet of the without significant compromise of lumen or distal occlusion.2.Examination of carotid system demonstrate a short segmental high grade stenosis or complete occlusion of the left proximal M2. Atherosclerotic irregularity and mild to moderate stenosis of the left M1 segment is also present. There is atherosclerotic disease of right cavernous carotid with high-grade stenosis. Atherosclerotic disease and high-grade vascular lumen compromise of the M2 segment of the anterior division of right MCA. Anterior cerebral arteries demonstrate mild atherosclerotic disease without high-grade stenosis or distal vessel occlusion.3.MRA often over estimate the degree of stenosis and if further assessment is clinically deemed necessary follow-up with CTA is recommended.