52 year-old hypertensive, diabetic, dyslipidemic, heavy smoker had two 30 minutes of right eye blindness. These spontaneously resolved. One week later he has an episode of left sided weakness and numbness, which resolved mostly within 48 hours.

NE

left pronator drift
left arm and leg hemianesthesia
decreased rapid successive movements in left (dominant) hand
left Babinski sign

Neuro-imaging shows normal CT scan.

Images

Questions:

1. What type of MRI is shown and what type of lesion is shown?
   
   
2. What does the angiogram show, especially where the arrow is directed?
   
   
3. What are the treatment management options (medical, surgical?)

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Films CT18 - Revised 6/21/2005