 There is no evidence of intracranial hemorrhage, mass, or acute infarct. High T2 signal and encephalomalacia are again seen in the left frontal lobe, right parietal lobe, right occipital lobe and right inferior cerebellar hemisphere. Since the previous exam there has been progression of the abnormal T2 signal in the right parietal lobe and left frontal lobe. There are also a few patchy areas of new high T2 signal in the right frontal lobe and left occipital lobe with no associated diffusion restriction. There is susceptibility artifact in the chronic right frontal lobe infarct and left frontal lobe infract compatible with hemosiderin staining.The midline structures and craniocervical junction are within normal limits. There is mild ex vacuo dilatation of the right lateral ventricle. The ventricles and basal cisterns are otherwise normal in size and configuration. There is no midline shift or herniation. No abnormal extra-axial fluid collection is identified. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA HEAD
1.No acute infarct, intracranial hemorrhage or mass.2.Interval progression of chronic ischemic disease in the regions and territories previously affected by ischemia.3.Stable MRA of the brain with multifocal high-grade stenosis in the anterior and posterior circulation.4.In the neck there is no significant stenosis in the carotid arteries. The cervical vertebral arteries are patent although there is thready opacification on the right.