 MRI brain:No evidence of restricted diffusion to suggest infarction. There are scattered foci of T2 hyperintensities in the periventricular and subcortical white matter without interval change. In addition, multiple chronic infarcts are redemonstrated in the bilateral cerebellum as well as bilateral posterior parietal lobes, unchanged from previous.No evidence of large intracranial hematoma. Ventricles are normal in size and configuration. No pathological enhancement is seen on postcontrast images.MRA brain:There may be some narrowing of the bilateral internal carotid arteries at the level of the anterior genu versus artifact. Otherwise internal carotid arteries show normal course and caliber. There is no definite high-grade luminal stenosis. The middle cerebral arteries are unremarkable. There is a hypoplastic right A1 segment. Only a single A2 segment is identified suggesting azygous configuration. There are prominent bilateral P-comm arteries. The basilar artery and PCAs are within normal limits. There is no evidence of flow-limiting stenosis or aneurysm.MRA neck: Please note that the origin of the great vessels are not well visualized due to technique. There is common origin of the brachiocephalic and left common carotid arteries. There is mild narrowing of the right carotid at the bifurcation, but without significant luminal stenosis. Again seen is a prominent internal maxillary artery arising from the right external carotid artery of uncertain clinical significance.The right vertebral artery is normal in course and caliber. The left vertebral artery is not seen on angiographic images, however, we do see a small V4 segment on the post contrast sequence. Non- visualization of most of the left vertebral artery may be related to hypoplasia versus proximal occlusion or severe narrowing.
1.No acute intracranial hemorrhage or acute infarction.2. Multiple scattered white matter T2 hyperintensities, which may be nonspecific, unchanged. Multiple chronic cerebellar as well as posterior parietal strokes are also unchanged.3. Again noted, the left vertebral artery is not definitely seen on angiographic images, however, there is demonstration of a small V4 segment on post contrast sequence. This appearance could reflect severe narrowing versus occlusion or a congenitally hypoplastic vessel. 4. Otherwise, no definite high-grade luminal stenosis is suspected in the anterior or posterior circulation. Redemonstration of Azygos configuration of ACA.