What Does "multiple Areas Of Deep White Matter T2/FLAIR Hyperintensity" In An MRI Mean?
multiple areas of deep white matter T2/FLAIR hyperintensity are seen, scattered throughout the right frontal and parietal regions, and on coronal imaging, these have a wedge-shaped appearance, radiating from the deep white matter peripherally towards the cortex. The largest of these lesions are seen anteriorly and posteriorly at the junction of the MCA & ACA/PCA vascular territories respectively. A lesion is also demonstrated at the anterior aspect of the posterior limb of the right internal capsule. These lesions demonstrate a variable degree of mild diffusion restriction on DWI sequences.
Several tiny subcortical white matter foci of signal alteration are seen within the left cerebral hemisphere also, these likely representing the sequelae of chronic small vessel ischaemic disease.
Gradient echo T2 sequences do not demonstrate the presence of susceptibility artefact to suggest blood products. CSF spaces are within normal limits for age (I am 42 - female) with no evidence of hydrocephalus. Susceptibility weighed imaging does not demonstrate the presence of intracranial haemorrhage.
Time-of-flight MRA has been performed from the level of the aortic arch, to include the circle of Willis. Dissection of the right internal carotid artery as it enters the skull base is demonstrated, with narrowing of the true lumen by approx. 80%. T1 weighted sagittal imaging demonstrates the high signal intramural haematoma. The remainder of the intra and extracranial ICA, both CCAs and the left ICA, have normal appearances, as does the remainder of the anterior circulation vessels. An ACom is visualised.
Co-dominant vertebral arteries are noted, with normal appearances to both of these arteries. Small bilateral PComs are also noted.
COMMENT: reads - A right internal carotid artery dissection is noted, at the point of its entry into the skull base. Multiple areas of ischaemic infarction some of these acute, but the majority subacute in nature are noted in the right ICA watershed distribution.
I basically understand the artery dissection part, but the rest I can't get my head around and am tired of trying to get it explained to me - I am not satisfied that there is obviously other things showing given my age.
MRI is suggestive of brain stroke on right side.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your MRI and MR angiogram brain details.
These are suggestive of brain stroke affecting the right side of brain. This means lack of blood supply to the right side of brain, which happened because of blockage of carotid artery on the right side.
This stroke on the right side of brain results in left-sided weakness, which would gradually resolve with physiotherapy and exercises.
Initial treatment of carotid artery dissection consists of oral anticoagulation with warfarin or acitrom tablets. If the lumen of carotid artery does not open up enough, a stent may be placed in the artery later on.
I hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
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