 Motion artifact degrades image quality.MRI BRAIN: There is no diffusion restriction to suggest acute infarct. There is encephalomalacia of the left cerebellar hemisphere, consistent with chronic left PICA territory infarct. There are associated areas of susceptibility effect in this region, consistent with hemosiderin deposition from remote hemorrhage. There is no evidence of acute intracranial hemorrhage or mass. There are very minimal punctate foci of T2 signal abnormality in the cerebral white matter, consistent with minimal small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There appears to be a small left posterior frontal developmental venous anomaly. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. MRA HEAD: The left A1 segment is hypoplastic. There appears to be mild irregularity of the left M1 segment without significant stenosis. There is focal stenosis of the right P2 segment. There is paucity of flow-related enhancement stenosis of the proximal V4 segment of the left vertebral artery. There also appears to be irregularity of the V4 segment of the right vertebral artery. There is mildly irregular flow-related enhancement in the bilateral carotid siphons, likely due to the presence of calcifications. There is no evidence of aneurysm.MRA NECK: There is paucity of enhancement in multiple locations along the course of the cervical portion of the left vertebral artery, particularly the V1 segment. The right vertebral artery flow void appears to be intact. There is mild stenosis of the left internal carotid artery near the bifurcation. The common carotid arteries and cervical internal carotid arteries are tortuous with a retropharyngeal course. There also appears to be mild stenosis of the left proximal internal carotid artery. There is a three vessel aortic arch. There is a small effusion at the left occipital-C1 articulation.
1. Chronic left PICA territory infarct, but no evidence of acute or subacute infarct.2. Multiple focal stenoses of the intracranial and extracranial vessels, particular involving the right P2 and left V1 and V4 segments.3. Mild stenosis of the proximal left internal carotid artery. Otherwise, no high-grade stenosis of the right internal carotid artery.Findings discussed with Dr. Verma on 1/5/2015 at the time of dictation.