Known basilar stenosis and right pontine lacunar infarct presenting with headache, vertigo and worsened left sided weakness and slurred speech. There is moderate cerebral white matter T2 hyperintensity bilaterally, particularly in a periventricular distribution. There is also encephalomalacia in the right pons with Wallerian degeneration in the right medulla. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The orbits are grossly unremarkable. The skull appears to be intact. There is a 6 mm thick left temporal scalp lipoma.
Findings suggestive of chronic small vessel ischemic disease and chronic right pons lacunar infarct, but no evidence of acute intracranial hemorrhage, mass, or acute infarct. Please refer to the prior CTA for details regarding the cerebral vasculature.