Left hand numbness and weakness. Brain MRI: There are areas of encephalomalacia in the left cerebellar hemisphere. There is also mild scattered cerebral white matter T2 hyperintensity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is no abnormal intracranial enhancement. There is nodularity along the lateral margins of the lateral ventricles with signal characteristics similar to that of cerebral cortex, left more than right. There is no midline shift or herniation. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is a right lens implant.Brain MRA: There is diffuse narrowing of the basilar artery. The vertebral arteries and anterior circulation are otherwise grossly patent, although the right vertebral distal to the PICA original is hypoplastic. There are prominent bilateral PCOM arteries. There is no evidence of cerebral aneurysms.Neck MRA: The bilateral cervical vertebral arteries are not readily apparent throughout much of the V1 and V2 segments. There is otherwise no evidence of significant steno-occlusive lesions of the right cervical vertebral artery or carotid arteries.
1. Chronic left cerebellar hemisphere infarcts and mild probable chronic small vessel ischemic disease, but no evidence of acute infract.2. No evidence of intracranial metastases.3. Nodularity along the lateral margins of the lateral ventricles is suggestive of subependymal nodular heterotopia.4. Diffuse narrowing of the basilar artery and apparent steno-occlusive disease of the bilateral cervical vertebral arteries. A CTA of the neck may be useful for further characterization, if clinically warranted.