 Brain MRI:There is a small, linear focus of hyperintensity on DWI images involving the right posterolateral pons near the brachium pontis, with hypointensity noted on corresponding ADC. However, this is an area of frequent artifact on diffusion imaging, although this may represent a small focus of acute ischemia, thus correlation with the patient's neurologic exam could determine whether this represents a real finding versus that of artifact.There is mild diffuse volume loss without findings of ventricular obstruction. Confluent T2 hyperintensity is noted within the white matter, as well as within the pons, without associated mass effect, restricted diffusion, or susceptibility of pneumonia. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. Note is made of a partially empty sella. There is no evidence for intracranial hemorrhage, There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified.
1.There is a small, linear focus of hyperintensity on DWI images involving the right posterolateral pons near the brachium pontis, with hypointensity noted on corresponding ADC. However, this is an area of frequent artifact on diffusion imaging, although this may represent a small focus of acute ischemia, thus correlation with the patient's neurologic exam could determine whether this represents a real finding versus that of artifact.2.Mild diffuse volume loss.3.Advanced chronic small vessel ischemic disease.4.Negative MRA of the brain.5.Negative MRA of the neck.