 Brain MRI:There is restricted diffusion involving the right cerebellar hemisphere and vermis in the right superior cerebellar artery territory compatible with acute infarct. There is corresponding T2/Flair signal abnormality indicating edema. Susceptibility weighted abnormalities are also noted in the right lateral cerebellar hemisphere compatible with a small amount of hemorrhage. A focus of T2/FLAIR hyperintensity is seen involving the the posterior limb of the left interna capsule with some susceptibility effect likely represent a chronic hemorrhagic infarct. Associated T2/Flair signal abnormality seen along the left corticospinal tracts compatible with Wallerian degeneration. in the subcortical white matter is nonspecific but compatible with small vessel ischemic disease.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. There is mild right maxillary mucosal thickening. 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. Small right posterior communicating artery. Left PCOM not definitively seen. There is common origin of the right posterior cerebral and superior cerebellar arteries which appear patent. Bilateral PICA are also patent.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 which are codominant. 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. Acute right cerebellar infarct in the right superior cerebellar artery territory. Small focus of susceptibility is seen within the infarct consistent with hemorrhage. 2. No significant mass effect or hydrocephalus. 3. Chronic lacunar infarct with hemorrhage involving the posterior limb of the left internal capsule with associated findings of Wallerian degeneration along the left corticospinal tract.4. No significant steno-occlusive disease of the major arteries of the brain and neck. Specifically no findings to suggest vertebrobasilar stenosis or dissection.