 Compared to the previous study dated 3/24/2015 the T2 and FLAIR high signal that was noted in the left periventricular white matter is less prominent, consistent of normal evolution of the infarction.Additionally, FLAIR and T2-weighted images demonstrate moderate chronic small vessel ischemic strokes of bilateral subcortical and periventricular white matter as well as left bilateral basal ganglia, the thalamus and extensively of the pons, unchanged from the previous study.There are new T2 and FLAIR high signal foci in the left cerebral peduncle, pons, and medulla. In addition, the size of the left cerebral peduncle appears to be a bit smaller than that of the right which likely representing Wallerian degeneration.Small retention cyst is seen in the sphenoid sinus.3D TOF MRA demonstrates nonvisualization of the right vertebral artery. Irregularities seen in the basilar and the vertebral arteries. There are luminal irregularities of the cavernous segments of bilateral ICAs.There is fetal origin of the right PCA.There is 10-20% narrowing of the carotid canal segment of the left ICA.There is 10-20% narrowing of the cavernous segment of the bilateral ICAs.No intracranial arterial aneurysm.MRV demonstrates a filling defect in the distal superior sagittal sinus, most likely due to intradural fibrous septa, forward flow through the region appears to be maintained.The left transverse sinus is not seen, likely represent hypoplastic dural sinus.Left sigmoid sinus also appears to be hypoplastic.Other major dural sinuses including deep venous drainage appears to be normal.
1.The left periventricular infarct that was noted in the previous study is less prominent, consistent with normal evolution. Otherwise, the study is unchanged. 2.Left vertebral artery not visualized.3.10-20% narrowing of the carotid canal segment of the left ICA and 10-20% narrowing of the cavernous segment of both ICAs.4.Normal MRV.