Case 5 - Childhood Stroke: MRI, MRA, MRP

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

Case Number 13 (Childhood Stroke)

EXAM: MRI of the brain with and without IV contrast, stroke protocol. MR angiography head without contrast

COMPARISON: MR of the brain from 2/20/2020.

TECHNIQUE: Multiplanar multisequence MRI of the brain with and without IV contrast. 3-D time-of-flight MRA of the circle of Willis with MIPS generated.

FINDINGS:

Brain:

Increasing restricted diffusion seen in the left MCA territory, most pronounced superiorly within the frontal corona radiata, centrum semiovale, and overlying cortex. There is a slight interval increase in the area of involvement in the region of the left frontal operculum as compared to the previous examination, with expected progression of diffusion changes involving the left basal ganglia and insula. No significant change in the other areas of restricted diffusion in the left MCA territory seen more inferiorly within the basal ganglia, frontal lobe, and insula/external capsule. Unchanged minimal restricted diffusion within the left temporal lobe. Expected evolution of the associated T2/FLAIR signal abnormality.

Minimal developing susceptibility artifact within the left basal ganglia which suggests hemorrhagic transformation of the infarct.

No midline shift or basal cistern effacement. Minimal effacement of the left lateral ventricle from mass effect secondary to the above mentioned edema. Ventricles otherwise within normal limits without hydrocephalus. Orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. Remonstration of the prominent cortical veins overlying the left frontoparietal convexities consistent with sluggish flow. No abnormal enhancement.

Qualitative assessment of the perfusion data demonstrates a matched flow and volume deficit throughout the areas of MCA stroke. Elevated Tmax is seen in the same areas with mildly elevated time to peak in the rest of the MCA distribution as noted on the prior exams.

MRA:

There is a tiny focal outpouching noted at the left MCA bifurcation measuring approximately 1 mm which could represent a small saccular aneurysm. 

The previously noted critical stenosis of the proximal left M2 artery branch appears to have largely resolved. 

There is extensive luminal irregularity of the ICA terminus and proximal/distal M1 segment with mild to moderate stenosis at the proximal M1. 

The right MCA, bilateral ACAs, bilateral PCAs, as are artery, and visualized vertebral arteries are patent without stenosis.

IMPRESSION:

1. Increase in the restricted diffusion in the left MCA territory, predominantly within the superior extent into the left frontal lobe. Evolution of the associated T2/FLAIR signal abnormality with mild mass effect on the right lateral ventricle.

2. Previously noted critical stenosis of the proximal left M2 artery appears to have largely resolved with more diffuse luminal irregularity to the left ICA terminus and left M1 with mild to moderate stenosis of the left M1 proximally.

3. Focal outpouching of the left MCA bifurcation measuring approximately 1 mm which could represent a tiny saccular aneurysm.

4. Qualitative assessment of the perfusion data demonstrates a matched perfusion defect in the area of MCA infarction.