 MRI BRAIN: Redemonstrated is subarachnoid hemorrhage along the right frontal lobe convexity, right paramedian interhemispheric fissure and a trace amount in the right Sylvian fissure. It is difficult to compare to prior study, but appears to be similar in distribution. There are either two adjacent foci or one linear focus of diffusion restriction within the right frontal centrum semiovale. There is a new focus of diffusion restriction in the left parietal lobe, which is new compared to 4/16/2015. The previously seen foci of diffusion restriction in the left cerebellar hemisphere have resolved.The ventricles and sulci are unchanged. The basal cisterns remain patent. There is no midline shift or mass effect. There are tiny bilateral cerebellar ischemic strokes, which are chronic. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild to moderate chronic small vessel ischemic changes. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is partial opacification of the right maxillary sinus and complete opacification of the left maxillary sinus. There are bilateral lens implants.MRA HEAD: Redemonstrated is a 1-2 mm atherosclerotic aneurysm at the anterior genu of the right internal carotid artery, without change. The anterior communicating artery again demonstrates a tiny bulge on the right, likely representing an infundibulum and likely at the origin off a perforating branch. The intracranial internal carotid arteries are otherwise normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis.MRV HEAD: The left transverse sinus is hypoplastic, which a normal anatomic variant. The superior sagittal sinus, right transverse sinus, sigmoid sinuses, straight sinus, vein of Galen, internal cerebral veins, and several visualized cortical veins are patent. The inferior sagittal sinus is not visualized. There is flow related artifact at the junction of the bilateral transverse and sigmoid sinuses. There is no evidence of venous thrombosis.
1. Small infarct in the right frontal centrum semiovale as well as a new small infarct in the left parietal lobe.2. Redemonstration of subarachnoid hemorrhage along the right frontal convexity, right paramedian interhemispheric fissure and right Sylvian fissure. 3. Stable 1-2 mm atherosclerotic aneurysm at the anterior genu of the right internal carotid artery. 4. Tiny infundibulum arising from the right side of a small caliber anterior communicating artery, likely at the origin of a perforating vessel.5. No evidence of venous sinus thrombosis. 