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
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.