altered mental status No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy scattered high signal intensities on FLAIR images on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The sphenoid sinus shows opacification.Bilateral mastoid air cells show fluid collections indicating possible mastoiditis. Clinical correlation is recommended.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal flow enhancement in bilateral ICAs, MCAs, ACAs and vertebrobasilar system.Acom artery and bilateral Pcom arteries are patent.There is no evidence of intracranial arterial aneurysm or stenosis.3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. Non specific small vessel disease as described above.2. No evidence of acute ischemic or hemorrhagic lesion on this scan.3. Normal brain MRA and neck MRA3. Sphenoid air cell opacification and bilateral mastoid fluid collections, clinical correlation is recommended. 