 MRI BRAIN: A focus of restricted diffusion with corresponding T2/FLAIR hyperintensity and T1 hypointensity is seen in the right middle cerebellar peduncle, either in the right AICA or the right PICA territorial perforator infarctions. Numerous T2/FLAIR hyperintensities are seen in the subcortical and periventricular white matter, in the centrum semiovale, and in the pons, which are increased since the previous study and represent chronic vascular ischemic changes. Susceptibility images demonstrate punctate blooming signal in the periventricular white matter representing blood products from chronic hemorrhages versus mineralization.MRA BRAIN:There is redemonstration of the right A1 aneurysm that measures 2 x 2 mm and is directing medially and posteriorly. There are atherosclerotic irregularities of the internal carotid arteries with no evidence of stenosis or aneurysm. The anterior communicating artery and the bilateral P-comm arteries are patent. The basilar artery and the vertebral arteries are patent. Note is made that the right vertebral artery is diminutive.There is a lens prosthesis in the left eye.
1. Restricted diffusion in the right cerebellar peduncle representing acute ischemic infarction.2. There are numerous T2/FLAIR hyperintensities, more prominent than in the previous study, in the subcortical and the periventricular white matter and the pons, representing chronic vascular ischemic changes.3. Small aneurysm of the right A1, unchanged since the previous study. 4. The right vertebral artery is diminutive. 