Altered mental status The trigones and occipital horns of the lateral ventricles as well as the posterior aspects of the bodies of the lateral ventricles are asymmetrically enlarged.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional patchy foci of signal hyperintensity on T2 and FLAIR MRI are present in the brainstem - predominantly the pons.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Flow void is identified in the left vertebral artery but not as well on the right vertebral artery.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Loss of the right vertebral artery flow-void is somewhat nonspecific and could represent stenosis or occlusion of the right vertebral artery. If clinically appropriate additional imaging of intracranial vasculature such as CT angiogram or MR angiogram may the helpful to further evaluate this.2.Ventriculomegaly, involving the posterior aspects of the lateral ventricles is a nonspecific finding but suspect to be a result of some volume loss of the cortical mantle posteriorly. This was present on the prior CT exams and is remote in time from leukomalacia.3.Periventricular and subcortical white matter changes as well as lesion in the pons of a mild degree are nonspecific. At this age they are most likely vascular related. 