 There is no diffusion abnormality. No intracranial mass or mass effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Small infarct involving the left cerebral hemisphere is noted and present on prior limited MRI from 2011. There is focus of susceptibility effect in the right cerebellar hemisphere consistent with chronic microhemorrhage and nonspecific. The ventricles and sulci are within normal limits for age. No extra-axial fluid collection is identified. The midline structures and craniocervical junction are within normal limits.MRA HEAD
1. No evidence of acute infarct. No intracranial mass or mass effect. Mild chronic small vessel ischemic disease. Small chronic infarct in the left cerebellar hemisphere which appears grossly unchanged. Focus of chronic microhemorrhage in the right cerebellar hemisphere which is nonspecific.2. MRA again demonstrates severe multifocal disease involving the posterior circulation in the head and neck as described above. Bilateral posterior cerebral arteries and superior cerebellar arteries appear to fill from the anterior circulation via large posterior communicating arteries. There is stable to mild worsening involving the multifocal high-grade stenosis and occlusion involving the vertebral arteries in the head and neck as well as the proximal basilar artery. CTA may be helpful for more accurate comparison.3. There is mild to moderate stenosis involving the right petrous internal carotid artery. The distal internal carotid, anterior, middle, and posterior cerebral arteries demonstrate no significant stenosis. 4. No significant stenosis involving the internal carotid artery origins in the neck.