 MRI brain: There are nonspecific T2/FLAIR hyperintensities in the periventricular and subcortical white matter most consistent with chronic small vessel ischemic disease and similar to prior MRI from 2011. A chronic lacunar infarct is seen in the right centrum semiovale and unchanged. There is no restricted diffusion. There are scattered foci of susceptibility consistent with chronic microhemorrhages in the bilateral cerebral hemispheres as well as the in the cerebellum with a nonspecific distribution. Ventricles are normal in size. There is no evidence of intracranial mass effect, midline shift, or herniation. No evidence of acute hemorrhage. There is mild global parenchymal volume loss, commensurate with patient's advanced age. There is prominence of the lacrimal glands which is again seen.MRA brain: The cerebral internal carotid arteries are patent. The anterior cerebral arteries are patent. The middle cerebral arteries demonstrates no significant stenosis. The posterior cerebral arteries are patent. The vertebral arteries are also patent with no flow-limiting stenosis or aneurysm.MRA neck: The cervical common and internal carotid arteries as well as the vertebral arteries in the neck demonstrate no flow-limiting stenosis.
1. There is no evidence of acute infarct. No intracranial mass or mass effect. No hydrocephalus.2. Evidence of mild chronic small vessel ischemic disease which appears similar to MRI 10/14/2011. Multiple scattered supratentorial and infratentorial foci of chronic microhemorrhages are again seen in a nonspecific distribution.3. MR angiogram of the brain and neck demonstrates no flow-limiting stenosis or aneurysm.