Clinical question: Left pulsatile tinnitus. Signs and symptoms: Left pulsatile tinnitus. Pre-and post-enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates few tiny foci of flair hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres which appear more conspicuous compared to prior study. Although nonspecific considering patient's stated age of 71 findings are suspected of very mild chronic nonhemorrhagic small vessel ischemic strokes.The anatomical morphology as well as the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences. Unremarkable study cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.Signal void of major intracranial arterial branches are identified. There is uniformly smaller size of basilar artery which is believed to be secondary to presence of prominent posterior communicating arteries. Unremarkable calvarium and soft tissues of the scalp. Unremarkable orbits, paranasal sinuses and mastoid air cells.Post-enhanced images demonstrate no detectable abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the orbits.Pre-and post-enhanced brain MRA:The visualized aortic arch and the origins of major vessels are unremarkable.Unremarkable brachial cephalic and bilateral subclavian arteries.Patent and unremarkable bilateral vertebral arteries and including their origins.Patent bilateral common carotid arteries, bilateral internal carotid arteries as well as the external carotid arteries.Minimal vascular lumen irregularity of the left upper cervical internal carotid artery which could represent atherosclerotic disease. There is no evidence of vascular lumen compromise.
1.Pre-and post-enhanced brain MRI demonstrate no evidence of acute intracranial process. Findings suggestive of very mild nonhemorrhagic chronic small vessel ischemic strokes.2.Unremarkable neck MRA.