65-year-old man with painful left side Horner's syndrome. History of lung cancer status post surgery, chemotherapy and radiation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged scattered punctate foci of white matter T2 hyperintensity. There is unchanged encephalomalacia in the left occipital lobe. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact.Neck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is an asymmetric appearance of the internal carotid artery flow voids, with areas of higher intraluminal signal. The osseous structures are unremarkable. The airways are patent. There is left apical scarring.
1.No evidence of metastatic disease in the head or neck, although portion of the neck are obscured by artifact on certain sequences.2.Unchanged minimal chronic small vessel ischemic disease and left occipital lobe cortical encephalomalacia.3. Asymmetric appearance of the internal carotid artery flow voids may be attributable to artifact or atherosclerotic plaque, although a dissection cannot be excluded. However, if there is persistent concern for dissection, dedicated vascular imaging is recommended.