 MRI brain: There is a subtle punctate focus of restricted diffusion within the floor of the fourth ventricle which may relate to acute ischemia. There is a punctate focus of susceptibility effect in the left parietal lobe which likely corresponds to the hyperdense focus seen on CT and is consistent with blood product. There is another focus of susceptibility in the left posterior frontal lobe. In addition, there is patchy susceptibility in the right frontal lobe sulci suggesting trace subarachnoid blood product. Small foci of susceptibility at the pontomedullary junction may also represent minimal hemosiderin staining. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is partially empty sella, incidentally noted. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is also in the midline Thornwaldt cyst in the posterior nasopharynx.  MRA brain: The intracranial internal carotid arteries show some evidence of atherosclerotic irregularity but probably no high-grade stenosis. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery and the posterior cerebral artery are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck: The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.
1. Trace subarachnoid blood products in the right frontal lobe.2. Corresponding to the hyperdense focus in the left postcentral gyrus on CT, there is susceptibility compatible with blood products. A few other scattered foci of susceptibility may represent hemosiderin of uncertain age.3. Moderate chronic small vessel ischemic disease.4. Small focus of acute ischemia along the floor of the fourth ventricle.5. Unremarkable MRA brain and MRA neck.