 He presented with 300, and I was the same officer, he was my colleague, and he examined him and I found he had a two-leaf of the left side of the face, lower face, that's all. So immediately I went to the hospital because I suspected an upper motor aero lesion, I suspected a stroke, and then after I did, Let's go to the case, I've written the findings here, but I'm going to show you a short video clip. Okay everybody, these are the first three days we call the Equal Acquisition Trivandrum CDs of brain MRIs. These are exosections of the brain, showing diffuse body electrophy, opposite brain hypertrophy of the lateral reticules, multiple lacular subordinate fonts on the right side, and evidences of brain ventricular ischemia. These are normal sections, which also show subordinate fonts from the right side, and these are cellular sections going from left to the middle, and they also show subordinate electrophy, brain ventricular ischemia. Thank you very much for watching, it's a gentleman, Dr. Sanjay Sanyal. So let's go to the next one. So these are some screenshots to show you basically what I do need to see now, so that you can see more clearly. You can see that there was a patient who was just 26 years old, but he has got his proportionate body electrophy, he has got obviously three hematropic electromentricles, he has got multiple lacular 3 to 4 millimeters of cortical infarcts, and I will show you the more of them, and yet more periventricular ischemia. These are fast, radiant, record, equal acquisition images, F-G-R-E. So we had to investigate further, so therefore I did a few more investigations. Three-dimensional and two-dimensional time of flight, spot radiant recall, equal acquisition, brain, magnetic resonance, angiograms of both the vertebral arteries and the carotid arteries. So these are the five dates, but let me show you another quick video clip. Take a very good look at the right vertebral artery. The next video series of three-dimensional time of flight spot radiant recall, MRA series of the brain. We have to imagine that the head is slowly spinning in a clockwise direction. We know this, the right vertebral artery is distinctly narrow compared to the left vertebral artery. The rest that we know is what appears to be an accessory right vertebral artery on the right side. The accessory right vertebral artery seems to have an abnormal communication with the narrow right vertebral artery, which itself appears to be bifid. As you can see clearly here, the association has a communication with the right vertebral artery, and it seems to have an abnormal distribution on the right side of the brain, which is not matched by a corresponding distribution on the left side of the brain. Thank you very much for watching. So now let's come to the final segment. So these are the screenshots. Now take a good look. This is the accessory right vertebral artery. This is the narrow right vertebral artery. And as you can see the next, this is a bifid narrow right vertebral artery. An accessory vertebral artery right side is having a communication with the bifid narrow right vertebral artery. And it also seems to have a communication with the right common internal carotid as well as it seems to have an abnormal distribution on the right side of the brain, which is not matched by a corresponding distribution on the left side of the brain. You have to imagine, when you saw the video, you have to imagine that the patient's head is slowly spinning in a clockwise direction. So these are some screenshots. Now this is the same thing shown to you in a two-dimensional time of light. Small gradient recall, equi-position MRE. Please take a close look. Remember that this is the right side and this is the left side. So this is the right vertebral artery. And as you can see, the right vertebral artery is a gentleman with up to a third demonstration, two-dimensional narrow right spot gradient recall equi-position. Straight away you can notice that the right vertebral artery is distinctly narrow compared to the vertebral artery. And as the slices move up, we notice that there's an accessory vertebral artery on the right side, which is separate from the narrow right vertebral artery. And as the slices move even further up, and as the right narrow vertebral artery is moving towards the left vertebral artery, we will notice that the narrow right vertebral artery has now become a biped right vertebral artery. And as the slices move even further up, we will notice that the biped portion is united with the accessory vertebral artery, while the right vertebral artery divides the narrow right vertebral artery. And here we see the beginning of the grounded circulation. Okay. So these are, again, the screenshots. Now, what I'm trying to focus is what was the cause, what was the diagnostic problem. This patient, remember, he had presented with a left-sided lower motor neuron and his lower face palsy. So we are trying to establish that. Okay, so these are screenshots of what I showed you just now. As you can see, this is the narrow right vertebral artery. This is the narrow right vertebral artery. And you can see that it is an accessory right vertebral artery here. So we did a two-dimensional time of flight. Spot-brain-required acquisition of the heriotic circulation also. Just to make sure what was the problem. Take a quick look at this video. This is the fourth week of the series, two-dimensional time of flight, spot-brain-required acquisition. Focus on what we showed you just now. So I think the right side is still narrow, as we mentioned earlier. And now we can see that they've been right in front of the visor artery, and the grounded side is in the grounded gap. The beef is part of the femoral bone. Now the grounded side is entering the military near Fossa. The grounded side is in the camera's side. Here's the grounded side. This is the community we've been in. Now the grounded side is in the center part. We can see the posterior vertebral artery is pointing out the circular peduncles. And the grounded artery is dividing into the middle circular artery. It's dividing the lateral fissure of the cilgis and the anterior circular artery in the nostril fissure of the brain. Here we can see the negative joint anterior, middle and posterior circular arteries, which are novel. Thank you very much for watching. So basically what we did was we traced even the grounded circulation and we found that the entire grounded circulation is novel. The middle circular artery, the anterior circular artery, or A1, A2, A3, M1, M2, M3, M4, and the P1, P2, P2A2B and P3, P4 were novel. And so the basic problem was what was the diagnostic problem? How did the patient develop this left-sided, low-motor neuron fissure pass? So anyway, we put the patient on ICU, we put the patient on statin, and his vision truly improved in the next 24 hours. And we discharged him and we advised him to take a lifestyle and modify the lifestyle. And what we did was he was free from neurological deficit. You see, isolated vertebral artery stenosis is a well-documented entity and the literature is full of them. Subcortical infarcts with transient ischemic attacks is also very well known. Multifarct dementia is also well-documented. But this was a case of a narrow, a biphen, right-vertical artery, an accessory right-vertical artery. He had multiple subcortical lacuna infarcts, lacuna these less than 5mm, 3-4mm more on the right side, and he had corticotrophy without dementia. He was a 46-year-old man and he had a fresh episode of left-sided facial weakness. So from what we have established now, we found that he did not have any large result disease. His parotids were all right, his ACA, his MCA, his PCAs were all right, all the four parts of MCA, four parts of PCA, three parts of ACA. But he did have accurate infarcts, so he did have small result disease and he did have more of them on the right side. As we saw in the first pictures, there's a fast gradient recall echo-equisition images. Now what we postulated was that perhaps the normal right-vertical circulation, right-vertebral artery, biphen right-vertical artery, accessory right-vertical artery with its abnormal communication may have been a cause of this more problem on the right side and this fresh episode may have been an episode of a fresh episode of small muscle disease. And that may explain the left-sided patient's findings. He obviously did not have any evidence of embolism or averaging strokes. So these are my extra reviews and thank you very much for watching and if you have any questions or comments, I'll be happy to answer them. Thank you very much.