ClariPACS

Neuro_MR_Brain: 92 M, TIA

MRI BRAIN STROKE PROTOCOL WITH AND WITHOUT CONTRAST:
 
CLINICAL HISTORY: 92-year-old male with acute onset of altered mental 
status. Episode concerning for TIA versus seizure.
 
FINDINGS:
 
BRAIN:
 
Parenchyma: There is
restricted diffusion within the right and left medial thalami extending to the right midbrain. This area is mildly T1 hypointense and T2 FLAIR hyperintense. There is associated 
increased susceptibility suggesting associated petechial hemorrhage.There are areas of confluent periventricular and patchy subcortical white matter hyperintensities which are likely secondary to chronic white matter microvascular ischemic disease. In addition, there is a chronic right frontal cortical infarct, and chronic lacunar infarcts involving the bilateral superior cerebellar hemispheres and posterior limb of the left internal capsule. There is no hemorrhage. There is no mass effect, midline shift, or herniation. 
There is age related mineralization of the deep grey nuclei.
 
Ventricles and extra-axial spaces: Appropriate for age.
 
Orbits: Normal.
 
Visualized paranasal sinuses: Clear.
 
Mastoid air cells: Clear.
 
Bones: Normal.
 
Additional comment: None.
 
INTRACRANIAL ANGIOGRAM:
 
Anterior circulation: No flow-limiting stenosis or aneurysm.
 
Posterior circulation: No flow-limiting stenosis or aneurysm. There 
is a hypoplastic left P1. There is suggestion of an
attenuated artery of Percheron
(image 98, series 8).
 
Dural venous sinuses: Patent. The internal cerebral veins are patent
 
Additional comment: None.
 
PERFUSION: 
Normal.
 
IMPRESSION:
 
1. Acute to subacute bilateral medial thalami infarcts extending to 
the right more than left paramedian midbrain, with suggestion of 
mineralization/petechial hemorrhage. Distribution and acute clinical 
presentation is most consistent with an artery of Percheron infarct. 
Deep venous structures are patent. No acute hemorrhage or mass effect.
 
2. Chronic white matter microvascular disease and scattered chronic 
small/lacunar infarcts. 
 
3. No flow-limiting stenosis. Possibly attenuated artery of Percheron 
is identified. Consider correlation with conventional angiography as 
clinically indicated.

(Artery of Percheron Infarct)


Accession: CL27388521

Study description: MR BRAIN WITH AND WITHOUT CONTRAST

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