L PICA infarct, R VA occlusion, multifocal intracranial stenosis

Findings:

A small focus of restricted diffusion and T2/FLAIR hyperintensity involves the left lateral posterior medulla. Flow signal is absent in the right vertebral artery above the PICA level with overall hypoplastic V4 segment. In addition to demonstrating right vertebral artery occlusion above PICA, multifocal intracranial arterial stenosis is present, including bilateral MCA and right PCA.

Differential Diagnosis/Discussion:

Wedge shaped diffusion restriction within a vascular distribution, without mass effect or expansile appearance, indicates acute infarction. It is important to note on MRA that congenital absence of the vertebral artery above PICA can be distinguished from occlusion by viewing the T2 weighted sequence. For additional discussion of stroke, please refer to multiple other cases on this site.

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