 MRI Brain:Susceptibility artifact overlying the left anterior frontal lobe slightly limits evaluation for acute ischemia and hemorrhage in this region. There is however no diffusion restriction to suggest acute ischemia. There is also no evidence of acute intracranial hemorrhage or intracranial mass. There is punctate focus of susceptibility consistent with chronic microhemorrhage involving the left inferior lateral cerebellar hemisphere and unchanged. Again seen are postsurgical changes of a left parietal craniectomy. Again demonstrated is extensive encephalomalacia involving the left MCA territory particularly the left lateral frontal, parietal and temporal lobes as well as the insula with associated ex vacuo dilatation of the left lateral ventricle. There is additional underlying mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific unchanged and likely related to mild chronic small vessel ischemic disease. Previously seen diffusion abnormality related to subacute infarct at the right temporal occipital junction has normalized consistent with evolution. No hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA Brain: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. There is attenuation of the distal left MCA branches coursing near the infarcted territory which may reflect decreased demand. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Left posterior communicating artery is small. The right posterior communicating artery is not definitively visualized. MRA Neck: There is origin of the left common carotid artery from the brachiocephalic artery which is a normal variant. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. There is suggestion of a small atherosclerotic plaque at the left internal carotid artery origin without significant stenosis. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.
1.No evidence of an acute infarct, hemorrhage, or mass effect. 2.Encephalomalacia in the left MCA territory compatible with a chronic infarct again seen. There has been evolution of a small right temporal-occipital infarct which was subacute on prior study from 9/20/2016.3.Diminutive distal left MCA branches in the infarcted territory which may reflect decreased demand. Otherwise, no flow-limiting stenosis involving the intracranial vasculature or the major arteries of the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.