Female, 71 years old, with facial droop. Assess for stroke, vascular stenosis. Brain MRI:No restricted diffusion is seen. There are, however, multiple patchy areas of periventricular T2 hyperintensity as well as several scattered discrete chronic lacunar infarcts in the basal ganglia and brainstem, the largest being in the right basal ganglia. Encephalomalacia of the left medial temporal-occipital junction is also seen. Small chronic infarcts of the cerebellar hemispheres are also noted.No evidence of parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles and sulci are mildly prominent compatible with volume loss including ex vacuo dilatation of the left ventricular atrium.Brain MRA:Mild irregularity of the cavernous ICAs is seen. Otherwise, no significant intracranial vascular stenosis or occlusion is detected. No aneurysms are identified.Neck MRA:Due to technical limitations and artifact, the origins of the great vessels are not well visualized. There may be mild atherosclerotic narrowing at the level of the right carotid bifurcation. No significant stenosis is suspected within the left carotid vessels. Likewise, the vertebral vessels are free of significant stenosis in the neck.
1.No evidence of acute ischemia.2.Sequelae of extensive chronic territorial, microvascular and lacunar ischemic disease.3.No significant intracranial vascular stenosis.4.MRA of the neck is somewhat compromised by artifact. At most, a mild stenosis may be present at the right carotid bifurcation.