 Multiple lacunar infarcts as well as a left posterior thalamic hematoma are again visualized and appear grossly similar to prior brain MRI although evaluation is limited on the provided sequences which are optimized for the vasculature. There is evidence of intracranial atherosclerotic disease with scattered areas of narrowing. The intracranial internal carotid arteries demonstrate no significant stenosis, with dense vascular calcifications involving the right cavernous ICA demonstrated on recent CT. There is mild to moderate multifocal narrowing involving the right middle cerebral artery M2 segments and minimal irregularity involving the right M1 segment. There is also at least moderate multifocal involving the right anterior cerebral artery in its distal A2 and A3 segments. Otherwise no high-grade stenosis in the anterior circulation. There is also mild irregularity involving the distal P1 as well as P2 segments of the right posterior cerebral artery as well as moderate to severe focal stenosis involving the left posterior cerebral artery at the left P2 segment. Bilateral vertebral and basilar arteries are patent. No evidence of aneurysm.
Multifocal narrowing involving the intracranial vasculature likely due to atherosclerotic disease. There is moderate to severe focal stenosis involving the left P2 segment. Additional stenoses as above. No high-grade stenosis involving the more proximal intracranial vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.