 There are several scattered foci of restricted diffusion in the bilateral cerebral hemispheres. These include the right superior frontal gyrus, bilateral corona radiata and centrum semiovale, right thalamus, left temporal lobe, as well as a splenule of the corpus callosum on the right. There is a background of patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter consistent with chronic small vessel ischemic disease. Multiple chronic lacunar infarcts including the bilateral centrum semiovale as well as the pons are evident. There are numerous foci of susceptibility compatible with chronic microhemorrhages throughout the brain. Relatively larger areas of chronic hemorrhage including the right cerebellar hemisphere as well as the left greater than right basal ganglia which may be be related to chronic hypertension. More peripheral foci of chronic hemorrhage may be related to amyloid angiopathy but are nonspecific. There is no intracranial mass or mass effect, midline shift, or herniation. No hydrocephalus. There is mild degree of global parenchymal volume loss which is advanced for age. MRA HEAD
1. Multiple scattered acute infarcts in the bilateral cerebral hemispheres superimposed on a background of moderate chronic small vessel ischemic disease with multiple chronic lacunar infarcts.2. Numerous foci of chronic microhemorrhage as well as relatively larger areas of chronic hemorrhage involving the right cerebellar hemisphere and left basal ganglia. Distribution is nonspecific but suggests chronic hypertension and possibly also amyloid angiopathy.3. Major intracranial arteries are patent.4. No high-grade stenosis or occlusion involving the bilateral common carotid, internal carotid, or left vertebral arteries. Right vertebral artery is diminutive which may be related to hypoplasia and/or stenosis. Motion degradation and lack of contrast limits evaluation. If further evaluation is warranted, suggest postcontrast MRA or CTA.5. Mild multilevel degenerative changes in the cervical spine without high-grade spinal canal stenosis or cord signal abnormality.