 MRI Brain:There is a small area of restricted diffusion involving the right corona radiata and extending inferiorly into the right lateral basal ganglia and insula. There is mild mass effect on the adjacent right lateral ventricular margin. Encephalomalacia within the left frontal lobe, left caudate, and left basal ganglia with associated adjacent ex vacuo dilatation of the frontal horn and anterior body of the left lateral ventricle consistent with chronic infarct. There is a small focus of susceptibility abnormality in the right frontal lobe which may represent chronic hemosiderin deposition.There is global volume loss and underlying periventricular and subcortical FLAIR hyperintense white matter lesions consistent with mild-moderate chronic small vessel ischemic changes. There are also chronic appearing patchy FLAIR signal abnormalities within the pons. There is no midline shift or herniation. There is prominent partially visualized upper cervical spondylotic changes with at least moderate central spinal canal stenosis at C3-C4. There is fluid in the right greater than left mastoid air cells.MRA Brain: The origin of the right M1 segment is occluded with collateral vasculature supplying a single more distal right temporal MCA branch. There is mild to moderate irregularity involving the left cavernous ICA segment with moderate focal stenosis involving the left supraclinoid ICA segment. The mid to distal left M1 segment is not visualized, with small caliber more distal left MCA branches with questioned tiny areas of curvilinear vasculature along the M1 segment again suggesting possible collateral supply. The left A1 segment is diminutive which may be developmental. The bilateral ACAs are otherwise patent. The left PComA is not visualized. The posterior circulation including the vertebral arteries, basilar arteries and PCA arteries are patent. No evidence of aneurysms or vascular malformations.
1.Small acute infarct involving the right corona radiata, lateral right basal ganglia and right medial insula. There is mild mass effect on the adjacent right lateral ventricular margin.2.Occlusion of the origin of the right M1 segment with collateral vasculature supplying a single right temporal MCA branch.3.Left frontal lobe, left caudate and left basal ganglia encephalomalacia indicating chronic infarcts.4.The mid to distal left M1 not visualized, with small caliber more distal left MCA branches with small areas of curvilinear vasculature again suggesting possible collateral supply.5.Moderate focal stenosis involving the left supraclinoid ICA. 