 MRI BRAIN: There is a punctate acute infarct in the left superior parietal lobule (series 1106 image 216). There are small to moderate sized acute infarcts in the left centrum semiovale and corona radiata, as well as linear diffusion restriction in the left temporal/occipital white matter tract adjacent to the left occipital horn. There is also a linear focus of diffusion restriction in the left cerebellum. There are otherwise stable moderate to severe nonspecific T2 white matter hyperintense signal likely representing severe chronic microvessel ischemic changes. There is an old infarct again seen in the right parietal lobe with encephalomalacia. There are small bilateral chronic cerebellar hemispheric, and brainstem infarcts. There is an unchanged small dural based lesion, presumably representing meningioma, along the right frontal dura measuring 14 x 7 mm on series 1301 image 20. There is no significant mass effect or vasogenic edema associated with this lesion. There are scattered small to punctate foci of susceptibility effect again seen in the right thalamus, the pons, and left cerebellar hemisphere probably representing chronic microhemorrhages. The left supraclinoid internal carotid artery flow void is seen, however the more proximal left internal carotid flow void is obscured which is slightly worsened from the prior exam. There is extensive diffuse volume loss. There is a cavum septum pellucidum et vergae, normal variant. There is a right maxillary sinus mucus retention cyst again seen.MRA BRAIN: There is moderate motion degradation limiting evaluation, especially of the smaller/distal arteries. There is significant tortuosity of the upper cervical right internal carotid artery. There is further decreased flow related enhancement in the infraclinoid left internal carotid artery with some reconstitution of the proximal left MCA and left ACA through collateral circulation. However, there is flow related enhancement present in the distal left MCA branches.There is an unchanged 3-mm aneurysm at the junction of the left posterior communicating artery and posterior cerebral artery. There is an unchanged 6 x 5 mm aneurysmal dilatation at the right internal carotid artery terminus. There are multifocal luminal irregularities in the ophthalmic and supraclinoid segments of the right internal carotid artery likely representing areas of mild atherosclerosis. There is unchanged luminal irregularity and narrowing of the right distal M1 segment representing moderate stenosis, although evaluation is somewhat limited due to motion.The diminutive left vertebral artery is barely visualized compared to the right with persistent near absent flow-related enhancement. The right vertebral artery predominantly forms the basilar artery. There are diffuse luminal irregularity of the diminutive basilar artery with multifocal areas of at least moderate luminal stenosis in the distal aspect, without significant change from prior exam. There is also redemonstration of moderate to moderate-severe scattered narrowing and irregularity at the right V4 segment, most conspicuous just inside the dural margin. Evaluation of the posterior cerebral arteries is limited due to motion artifact, however there is again paucity of the distal PCA branches bilaterally, with narrowing of the right P1-P2 junction, left proximal P2, and scattered along the right P2 segment.MRA NECK: There is moderate motion artifact and lack of IV contrast significantly limiting evaluation. The right vertebral artery origin is not well visualized with evaluation limited by artifact. The remaining great vessel origins appear grossly intact allowing for the motion artifact. The right internal carotid artery origin appears mildly irregular with prominent flattening of the carotid bulb with likely mild narrowing. However, the left internal carotid artery shows at most minimal flow related enhancement just at the origin, compatible with occlusion.
1.Acute scattered small to moderate foci of infarction in the left centrum semiovale, corona radiata, left cerebellum, as well as left occipital/temporal white matter without evidence of hemorrhage. This is likely related to an embolic phenomenon. Underlying severe chronic small vessel ischemic changes.2.Stable small right frontal dural based mass presumably representing meningioma without associated mass effect or vasogenic edema.3.Limited MRA of the neck. Long segment occlusion of the left internal carotid artery essentially from its origin.4.Limited MRA of the brain due to motion artifact. Further decreased flow related enhancement in the distal left internal chronic artery, with reconstitution of flow in the left MCA and ACA.5.Grossly stable 6-mm right internal carotid artery terminus aneurysm, and 3 mm left PCA/PCOM junction aneurysm.6.Redemonstration of extensive atherosclerotic disease involving intracranial vasculatureI personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.