 MRI Brain:Image quality is significantly limited by motion artifact. There are numerous small foci of restricted diffusion in the supra and infratentorial parenchyma compatible with acute infarcts. There is no focal mass effect, and no indication of hemorrhagic conversion. There are a few areas of punctate susceptibility abnormality not correlated with the areas of restricted diffusion, likely related to chronic microinfarcts. There is severe underlying periventricular and subcortical T2/FLAIR white matter signal abnormality including within the brainstem, middle cerebellar peduncles and white matter tracks of the cerebellar hemispheres. There is also mild diffuse volume loss out of portion to patient's age.MRA Brain: There is minimal luminal irregularity involving the cavernous and paraclinoid portions of the intracranial ICAs bilaterally. There is also multifocal atherosclerotic irregularity involving the anterior cerebral arteries. A moderately severe focal stenosis affects the distal left M1 segment with scattered mild to moderate focal stenoses more distally in both MCA distributions. Mild luminal narrowing affects the bilateral V4 segments. The basilar artery is within normal limits. Scattered mild to moderate focal stenoses are evident in the distal PCAs, left side more than right. No evidence of aneurysms or vascular malformations.
1.Numerous small nonhemorrhagic infarcts involving the supra and infratentorial brain parenchyma without mass effect or hemorrhagic conversion.2.Multifocal scattered mild to moderate atherosclerotic stenoses of various aspects of the intracranial vasculature with details as above.3.Underlying severe chronic small vessel ischemic disease and diffuse volume loss.