 MRI Brain:There is a small area of restricted diffusion involving the left corona radiata which is compatible with an acute infarct, just cranial to a smaller old lacunar infarct. There is no associated mass effect or susceptibility. Again seen are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate to severe chronic small vessel ischemic changes. This includes patchy abnormal signal within the pons and scattered chronic lacunar infarcts.There are numerous scattered punctate foci of susceptibility abnormality throughout the cerebral hemispheres bilaterally with perhaps a few new foci compared to the prior exam. The ventricles and sulci are prominent but unchanged, consistent with moderate age-related volume loss. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Mucous retention cysts or polyps are seen in the maxillary sinuses bilaterally. There is patchy mucosal thickening involving the ethmoid air cells.MRA Brain: The intracranial internal carotid arteries are normal in course with mild dolichoectasia. There is mild focal narrowing of the left proximal M1 segment, unchanged. There is also scattered focal narrowing of bilateral M2 segments, just before entering the sylvian fissure, unchanged. The middle and anterior cerebral arteries are otherwise unremarkable. There is mild multifocal irregularity and narrowing of the left P2 segment, unchanged. The right posterior cerebral artery distal to the P1 segment is mildly diminutive compared to the contralateral side but this is stable. The vertebral arteries, basilar artery, and posterior cerebral arteries are otherwise normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is a medialized right carotid bifurcation and bulb, and moderate plaque along the left carotid bifurcation, minimal on the right. There is some tortuosity of the distal right cervical internal carotid artery. The remainder of the common carotid arteries and cervical internal carotid arteries are otherwise unremarkable. Both vertebral arteries are tortuous but patent. There is no evidence of stenosis or occlusion.
1.Acute infarct involving the left corona radiata but without significant mass effect or associated susceptibility.2.Moderate-severe chronic small vessel ischemic disease, unchanged. 3.Scattered foci of susceptibility likely relating to chronic hemosiderin deposition possibly from amyloid angiopathy or hypertensive microhemorrhages are similar in appearance.4.No significant flow limiting stenosis involving the intracranial or neck arteries.