Female, 79 years old, dysarthria. No restricted diffusion is seen. An area of encephalomalacia within the posterior left frontal lobe is compatible with a chronic infarct. A few scattered foci of T2 hyperintensity are evident within the periventricular and subcortical white matter, likely representing chronic microvascular ischemic disease. Small chronic lacunar infarctions are suspected within the basal ganglia. A small chronic infarct of the left cerebellum is also seen.No significant intracranial hemorrhage is seen. No abnormal extra axial fluid collections are detected. There is no mass-effect or parenchymal edema. Ventricles are within normal limits. Imaging of the intracranial vasculature shows no evidence of significant stenosis or occlusion. There is likely moderate atherosclerosis of the cavernous ICAs. No aneurysms are detected within the limitations of technique.Imaging of the neck reveals a common origin of the brachiocephalic and left common carotid arteries. Mild atherosclerotic narrowing is evident at the carotid bifurcations without significant stenosis by NASCET criteria. The vertebral vessels are free of significant stenosis.
1. No definite acute intracranial abnormality including no evidence of acute ischemia.2. A lesion seen in the posterior left frontal lobe on prior CT most likely represents a chronic infarct.3. Scattered additional areas of chronic ischemic injury are seen.4. Dedicated vascular imaging shows no evidence of significant stenosis or occlusion in the head or neck.