 Motion degraded exam. There are a few punctate foci of restricted diffusion in the left cerebellum, right periventricular occipital lobe, left subcortical occipital lobe and tiny foci in the subcortical parietal lobes consistent with acute infarcts. There is a punctate focus of restricted diffusion in the left dorsal paramedian mid brain.There is an area of diffusion hyperintensity in the right precentral gyrus with associated increased T2 FLAIR signal and hyperintense signal on ADC consistent with chronic infarct. There are foci of susceptibility effect associated with this lesion consistent with chronic blood products or perhaps mineralization related to prior infarct. Another area of restricted diffusion and hyperintense signal on ADC in the right parietal lobe is also related to chronic infarct. Additional foci of diffusion hyperintensity and hyperintensity on ADC in the left frontal lobe likely represent chronic infarcts as well.There are punctate and confluent areas of T2 FLAIR hyperintense signal in the background cerebral parenchyma which is compatible with mild to moderate chronic small vessel ischemic changes. The ventricles and sulci are mildly prominent compatible with age appropriate volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of pathological enhancement. No extra-axial fluid collection is identified.No obvious enhancing orbital mass seen within the limitation of motion degraded exam. Dedicated orbital MRI was not obtained due to motion degradation.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.There are few T2 hyperintense enhancing lesions in the bilateral frontal calvarium which measures up to 1 cm and are nonspecific.MRA HEAD
1. Multiple punctate foci of restricted diffusion in the left dorsal paramedian midbrain, left cerebellum, bilateral parietal lobes, and bilateral occipital lobes consistent with acute infarcts.2. Areas of chronic infarcts in the right precentral gyrus, right parietal lobe and left frontal lobe as described above.3. Background of mild to moderate chronic small vessel ischemic disease.4. Significantly degraded MRA brain, which limits the evaluation of aneurysm. Severe atherosclerotic narrowing of the V4 segment of the right vertebral artery. Otherwise, no evidence of high-grade stenosis or occlusion in the anterior or posterior circulation.5. Few T2 bright enhancing lesions in the bilateral frontal calvarium measuring up to 1 cm which are nonspecific. Suggest follow-up imaging or outside comparison studies if available.