 Exam is limited by patient motion. There are areas of cortical diffusion restriction along the right superior temporal and right lateral frontal parietal region. Areas of sulcal susceptibility and FLAIR hyperintensity are also identified in these areas, consistent with the subarachnoid blood products seen on recent CT. Other scattered foci of susceptibility are similar to that of the prior exam, including within both thalami. There is a new left superior frontal gyrus oval area of susceptibility consistent with the previously seen small parenchymal hemorrhage, grossly unchanged. There is also slight increased conspicuity of very faint susceptibility in the left frontal deep white matter as compared to the prior MRI, corresponding to an area of subtle hyperdensity on CT. This may represent developing mineralization. There is a punctate focus of diffusion restriction in the right frontal deep white matter as seen on 501/215.Post-contrast images do demonstrate left carotid canal on the fat saturated postcontrast images which may relate to slow flow of contrast within the vessel.Compared to the recent CT, there are stable bilateral well hemispheric subdural effusions, slightly greater on the left side. On the left, the collection measures up to 11 mm in thickness, with long the right measures 8 mm. These are approaching CSF signal intensity on all sequences. There is no pathological enhancement. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or significant mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes including numerous scattered lacunar infarcts.The midline structures and craniocervical junction are within normal limits. MRA HEAD
1. Abnormal cortical diffusion restriction along the right superior temporal lobe and just cranially along the right lateral frontal parietal region, with associated areas of subarachnoid as well as parenchymal hemorrhage. Given background of numerous foci of susceptibility, this is felt to be most likely related to amyloid angiopathy, perhaps the rare inflammatory type, which can results in hemorrhagic infarcts.2. Redemonstration of left superior frontal gyrus parenchymal hemorrhage.3. Stable appearance of the thin left greater than right near CSF signal intensity subdural effusions, new since prior MRI.4. Complete occlusion or near occlusion of visualized portion of left internal carotid artery with likely minimal slow flow along the carotid canal on post contrast images, that is most likely chronic. CTA of the head and neck may be obtained for further evaluation.5. Mild stenosis and irregularity of the mid to distal basilar artery and the right P2 segment. Moderate focal narrowing at the left A1 segment origin. Decreased flow related enhancement in the left middle cerebral artery branches. Moderate irregular in narrowing of the cavernous right internal carotid artery.6. Unremarkable MRV head.