61 year-old female with cognitive changes and memory loss. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. Right cerebellar hemispheric encephalomalacia, compatible with remote infarction with mild associated vacuo dilatation of the fourth ventricle. There is complete loss of the flow void of the distal right V3 segment of the vertebral artery with partial distal reconstitution along the right V4 segment likely representing retrograde flow.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, pons and medulla which are nonspecific, but compatible with chronic small vessel ischemic changes. Sella and orbits are grossly within normal limits. Trace fluid in the right mastoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.
1. No evidence of intracranial hemorrhage, mass, or acute infarct.2. Moderate chronic small vessel ischemic changes as described above.3. Stable remote extensive right cerebellar infarction.4. Loss of the right vertebral artery (V3 segment) flow void flow as seen on prior ultrasound with partial distal reconstitution of right V4 segment likely representing retrograde flow. If further evaluation of the vasculature is clinically warranted, CTA or MRA may be considered.