Bilateral MCA infarcts

Findings:

MRI FLAIR and diffusion images demonstrate a large recent left MCA distribution and a large remote right MCA distribution infarct.

Collapsed MRA images demonstrate absence of MRA detectable flow in the bilateral internal carotid, middle cerebral, and anterior cerebral arteries. The intracranial segment of the left vertebral artery is occluded and there is a high-grade stenosis of the dominant right vertebral artery below the level of PICA.

There is moderate to severe stenosis of the distal left PCA in the ambient cistern. Little or no supratentorial MRA detectable flow signal is seen on the source images.

Discussion/Differential Diagnosis:

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