 MRI brain:There is an area of restricted diffusion in the periventricular coronal radiata extending to the right basal ganglia consistent with acute ischemic infarct. There is a small focus of restricted diffusion in the right pons also relate to acute stroke.There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. Additional scattered old infarcts are seen mostly in the left cerebral cortex in the frontal and parietal lobe. There is mild global parenchymal volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is minimal opacification of the right more than left mastoid air cells. MRA head: The intracranial internal carotid arteries are normal in course and caliber. The right A1 segment is hypoplastic. Otherwise anterior cerebral is is normal in course and caliber. There is a right P-comm artery. The proximal middle cerebral artery is unremarkable. There is paucity of more distal branches of the right middle cerebral artery. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. MRA neck: MRA of the neck is significantly degraded due to patient motion and is virtually a nondiagnostic exam.
1. Restricted diffusion in the right periventricular corona radiata extending to the right basal ganglia consistent with acute ischemic stroke. Additional punctate focus of acute ischemia in the right pons.2. Moderate chronic small vessel ischemic disease. Multiple chronic left cortical infarcts and lacunar infarct in the right basal ganglia.3. Paucity of right distal MCA branches, otherwise no significant stenosis or aneurysm in the proximal intracranial anterior or posterior circulation.4. Poor quality MRA neck which is nondiagnostic.