 MRI Brain:The exam is limited by motion artifact. There is an area of restricted diffusion involving the right middle and inferior frontal gyri compatible with an acute ischemic infarct. There is associated FLAIR signal abnormality and sulcal effacement. Additional scattered punctate foci of FLAIR hyperintensity are consistent with chronic small vessel ischemic changes. Encephalomalacia is visualized in the right occipital lobe indicating an old infarct.Bilateral prominent perivascular spaces versus lacunar infarct are visualized along the basal ganglia. There is diffuse age-related volume loss. There is no evidence of acute intracranial hemorrhage, midline shift, herniation, hydrocephalus or extra-axial fluid collection. The major cerebral flow voids are intact. Incidental note is made of bilateral exophthalmos.MRA Brain: The exam is limited by motion artifact. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries and basilar artery are patent with no significant stenosis. There are fetal-like PCAs noted bilaterally which are patent. No evidence of aneurysm or flow-limiting stenosis.
1.Small acute to subacute ischemic infarct involving the right middle and inferior frontal gyri.2.Right occipital lobe chronic infarct.3.Mild underlying chronic small vessel ischemic disease.4.No evidence of aneurysm or flow-limiting stenosis involving the intracranial arteries.