 BRAIN MRI:There are foci of restricted diffusion in the right thalamus, left globus pallidus, and there is left aspect of the pons. These corresponds to the increased T2 and FLAIR signal in the same location.Nonspecific periventricular white matter punctate foci of high signal is seen in T2 and FLAIR, representing small vessel chronic ischemic disease.There are multiple pontine lacunar infarcts, mostly hemorrhagic.Chronic small vessel disease is seen in the left basal ganglia.There are cerebellar linear high signal in T2 and FLAIR in both hemisphere due to chronic infarction with encephalomalacia, seen in the left hemisphere more than the right cerebellar hemisphere.Ventricular size is normal with no evidence of mass effect or edema. No definite evidence of bleed.There is near complete opacification of the left maxillary sinus.BRAIN MRA:There is narrowing of the left internal carotid artery of moderate degree in the precavernous segment. This report clinically. The left internal carotid artery is patent. Irregular diffuse narrowing of the left MCA is seen consistent with atherosclerotic disease.The right internal carotid artery demonstrates mild stenosis of the precavernous and of the cavernous segment. The right MCA is patent. Both anterior cerebral arteries are patent.There is hypoplastic right A1 segment which is a normal variant. No evidence of occlusion in the anterior circulation.There is mild vascular linear impression and atherosclerotic ectasia of the basilar artery. Mild atherosclerotic irregularities of the posterior cerebral arteries seen. The posterior cerebral arteries are patent with no evidence of occlusion.
1. Diffusion restriction in the pons, right thalamus, and the left globus pallidus, representing acute ischemia.2. Extensive vertebro-basilar circulation chronic ischemic disease as detailed. 3. Chronic ischemic disease is seen in the midbrain, periventricular white matter, and the basal ganglia and chronic bilateral cerebellar(L>R) chronic ischemic strokes