89 years Female (DOB:5/12/1927)Reason: Assess for location of stroke History: R hemianopsia, gait imbalancePROVIDER/ATTENDING NAME: IRA J BLUMEN KOUROSH L REZANIA MRI of the brainThere are patchy foci of diffusion restriction present along the left inferior parietal lobule. This can also be identified on FLAIR and T2 imaging. On susceptibility imaging there are prominent signal voids along the left angular artery and even to some degree the right angular artery relative to the previous exam. Comparing to the MRA exam the signal voids are disproportionately larger. The other appears to be flow in the right angular artery there is not appear to be flow in the left angular arterySince the prior exam the patient has developed susceptibility effect along the deep gray nuclei of the right cerebellar hemisphere which is associated with volume loss and T2 and FLAIR signal hyperintensity suggesting interval infarction since 2012..There is redemonstration of a encephalomalacia along the left superior and middle temporal gyri anteriorly which was also present on the previous exam. There is redemonstration of some encephalomalacia along the right temporal lobe anteriorly. There is associated exact effect on the right lateral ventricle more than the left lateral ventricle.There is a moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are patchy signal hyperintensities along the brainstem on T2 and FLAIR imaging.There appears to be stenosis in the upper cervical spine at C3-4.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. There is asymmetry in of the superior and inferior division branches demonstrate flow along their proximal most portions it appears that there is diminished flow distal to that along the inferior division.There is a high-grade stenosis present along the left A3 segment and milder narrowing of the right A3 segment. There is also attenuation of the right angular artery.There is a 60% stenosis present at the left internal carotid artery at the distal cavernous segment.There is redemonstration of a an aneurysm along the left internal carotid artery adjacent to the anterior clinoid which measures 5 x 4 mm. It does not appear to have changed substantially when compared to the previous exam. It is directed laterally is located in the clinoidal segment.The anterior communicating artery is identified and is medium size. The left A1 segment is hypoplastic. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.Findings suggest the partial occlusion of the left middle cerebral artery territory along the M2 portion of the inferior division and occlusion or near complete occlusion of the left angular artery.2.There is patchy appearing subacute infarction along the left inferior parietal lobule.3.There is distal intracranial cerebrovascular occlusive disease. There are distal arterial stenoses present along the anterior cerebral arteries bilaterally but more the left A3 segment when compared to the right as well as in attenuation of distal branches such of the right angular artery. The posterior cerebral arteries are not imaged significantly distal to the P2-3 junction.4.There is 60% stenosis at the distal left internal carotid artery.5.Encephalomalacia along the right cerebellum related to an infarction which was documented on 6/19/20126.Encephalomalacia along the anterior lateral aspects of the temporal lobes bilaterally.7.Periventricular and subcortical white matter lesions of a moderate degree and patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 