 MRI findings: Extensive areas of restricted diffusion in the bilateral medial temporal lobes, right more than the left occipital lobe, left more than the right cerebellum, midbrain and pons compatible with acute infarction. There is T2 hyperintensity and encephalomalacia in the left inferior cerebellum, left occipital lobe and pons compatible with chronic infarcts. There is mild periventricular white matter hyperintensity related to chronic small vessel ischemic disease. No evidence of susceptibility foci are evident.There is mild global parenchymal volume loss. No evidence of mass effect or midline shift. The basal cisterns remain patent. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. MRA head findings: Please note this is motion degraded exam as well as technically limited. The intracranial internal carotid arteries are normal in course and caliber. The anterior and middle cerebral arteries show flow related signal with some wall irregularity but without hemodynamically significant stenosis or occlusion. The left vertebral artery is not opacified. The right vertebral artery is diminutive beyond the proximal V4 segment. The basilar artery is not visualized. The posterior cerebral arteries are also not visualized. Bilateral PCOM arteries appear to be present but they do not apparently compensate for the vertebrobasilar abnormalities.MRA neck findings: The common carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. There is some narrowing at the carotid bifurcations but without high-grade stenosis or occlusion.Bilateral vertebral arteries are poorly visualized which may be technical or could be related to atherosclerotic disease.
1. Extensive areas of acute infarction involving the bilateral medial temporal lobes, right more than the left occipital lobe, left more than the right cerebellum, midbrain and pons.2. Lack of flow in the vertebrobasilar circulation compatible with severe stenosis or occlusion.3. No significant vaso-occlusive disease in the anterior circulation.Above findings were discussed with Dr Warnecke at 10:30 hours on 12/21/2015.