 BRAIN MRI:A small focus of questioned diffusion collection is seen in the left insular cortex with no corresponding FLAIR abnormality.There is moderate volume loss of the right parieto-occipital lobe with encephalomalacia and ex vacuo dilatation of the right lateral ventricle. There are also smaller scattered areas of encephalomalacia in the right frontal lobe.There are patchy foci of high signal in T2 and FLAIR in the periventricular white matter and in the subcortical white matter of the frontal and the parietal lobes, more on the right than the left. This represents chronic small vessel ischemic changes. Extensive patchy abnormal signal of T2 and FLAIR is seen in the pons.Linear susceptibility is seen along the lateral margin of the ex vacuo dilated right occipital horn, at least in part due to calcification seen on CT as well as chronic blood products.There is no midline shift. No evidence of bleed, mass effect, or edema. Flow void is not seen in the right ICA. The right MCA flow voids appear diminutive in caliber. The remainder of the intracranial vascular structures demonstrate normal flow voids.MRA BRAIN:There is no flow-related enhancement associated with the right internal carotid artery. The left internal carotid artery is patent.The right A1 is diminutive in caliber and incompletely assessed, possibly developmental. There is normal left A1 artery and there is a single A2 trunk.The right middle cerebral artery branches are small in caliber compared to the left side, relating to collateral flow. The left middle cerebral artery is patent and normal in caliber. Small right P-comm visualized. The left P-comm is not visualized.The right posterior cerebral artery is normal. The proximal left P2 segment is irregular. The basilar artery is patent, as are the vertebral arteries.
1. Small focus of diffusion restriction is seen in the left insular cortex with no corresponding FLAIR abnormality, which may represent a tiny early infarct or may be artifactual. Please correlate clinically.2. Chronic occlusion of the visualized right ICA. Diminutive right middle cerebral artery branches, likely supplied by collaterals. Right A1 segment is diminutive and incompletely assessed, although possibly developmental. MRA neck may be helpful for a more complete evaluation.3. Right occipital encephalomalacia with other scattered areas of encephalomalacia in the right frontal lobe. Underlying moderate chronic small vessel ischemic changes.4. Proximal left P2 segment is irregular.