66 year old female with cognitive impairment, altered mental status, evaluate for stroke or brain injury MRI Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There is global parenchymal volume loss, relatively greater in the bilateral frontal and parietal lobes. There is hippocampal volume loss which is not disproportionate to the remainder of the brain. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Small foci of volume loss and FLAIR hyperintensity along the left lateral ventricle margin are compatible with lacunar infarcts. Brain parenchyma is otherwise unremarkable for age. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. MRA Brain: There is irregularity and moderate narrowing involving the bilateral cavernous internal carotid arteries likely related to atherosclerotic disease. There is diminished flow-related enhancement involving the left distal vertebral artery with reconstitution distally. The bilateral ACAs, MCAs, basilar artery, and PCAs demonstrate no significant stenosis. No aneurysms are appreciated.
1. No evidence of acute infarct, mass or mass effect. 2. Mild chronic small vessel ischemic disease. 3. Global parenchymal volume loss relatively greater in the bilateral frontal and parietal lobes.3. Intracranial atherosclerotic disease with moderate narrowing involving the cavernous internal carotid arteries and V3 segment of the left vertebral artery. These stenoses can be better visualized with CTA if clinically indicated.