word finding difficulties No evidence of acute ischemic or hemorrhagic lesion on this scan.There is encephalomalacia with hemosiderin deposition on the left precentral gyrus, left insular as well as left superior temporal gyrus indicating prior hemorrhagic infarction.Patchy high signal intensities on bilateral periventricular white matter on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Acom artery is patent but bilateral Pcom arteries are not seen.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery origin is normal. The right vertebral artery origin appears to be a bit narrowed but this could well be an artifactual. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Chronic hemorrhagic infarction involving the left insular, inferior aspect of frontal lobe (precentral gyrus) and superior temporal lobe as described above.2. Non specific small vessel ischemic disease.3. No evidence of acute ischemic or hemorrhagic lesion.4. Normal brain and neck MRAs. 