 MRI findings: There is no diffusion abnormality to suggest acute ischemia. No evidence of intracranial hemorrhage. There is no abnormal enhancement in the bilateral cavernous sinuses. Bilateral orbits and chiasm are grossly unremarkable. There is mild global parenchymal volume loss. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter as well as the pons, consistent with moderate chronic small vessel ischemic changes. Incidentally noted is partially empty sella, normal variant. No extra-axial fluid collection is identified. There is a tiny maxillary mucous retention cyst, otherwise paranasal sinuses are clear. The visualized portions of the orbit is unremarkable.MRA findings: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries also demonstrate no significant stenosis.There is mild irregularity of the basilar artery, likely related to mild atherosclerotic changes. Otherwise, the basilar artery is patent without evidence of high-grade stenosis or aneurysm. P1 segment of right posterior cerebral artery is hypoplastic with the right PCA predominantly fetal in origin. The left PCA is unremarkable. The right vertebral artery is normal in course and caliber. The V4 segment of the left vertebral artery is small with the partially visualized V3 segment of the left vertebral artery appearing larger indicating that there is likely moderate stenosis involving the left V4 segment rather than hypoplasia.
1. No intracranial mass or mass effect. Moderate small vessel ischemic changes including involvement of pons. No findings to suggest acute ischemia.2. No significant stenosis involving the basilar artery. There is moderate stenosis suspected involving the left V4 segment. Otherwise no significant stenosis in the anterior or posterior circulations.