stroke, right facial weakness and dysarthria There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are encephalomalacia with high signal intensity lesion on FLAIR images on the left external capsule, basal ganglia and caudate head indicating chronic ischemic infarction. The right external capsule also shows similar lesion.There are also multifocal scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections show Left ACA A2 segment shows more than 50% of luminal narrowing. In addition, there is proximal right MCA M1 segment narrowing about 50%. These two findings may indicate intracranial atherosclerosis. Acom artery and right Pcom artery are patent but the left Pcom artery is not seen.Vertebrobasilar system appears to be normal.There is no evidence of intracranial arterial aneurysm or major vessel occlusion. 3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal chronic ischemic infarctions with encephalomalacia as described above.3. Non specific small vessel disease.4. Intracranial atherosclerosis demonstrating left ACA A2 and right MCA M2 segment stenosis (more than 50%).5. Normal neck MRA. 