 Brain MRI:There are no areas of restricted diffusion to suggest acute infarct. Encephalomalacia along the posterior aspect of the right insula, anterior/inferior aspect of the right parietal lobe, and posterior/inferior aspect of the right frontal lobe is again noted with associated T2/flair hyperintensity along the right centrum semiovale. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear.Brain MRA: There is antegrade flow within the distal bilateral internal carotid arteries, the proxima bilateral anterior, middle and posterior cerebral arteries, distal bilateral vertebral arteries, and within the basilar artery. No arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. The right A1 is hypoplastic, the bilateral anterior cerebral arteries fill from left. There is fenestration of the anterior communicating artery with an appearance similar to prior studies. Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. The right internal carotid artery appears smaller in caliber when compared to the left, unchanged from prior. There is irregularity of the lumen of the distal cervical segment of the right internal carotid artery at the site of the prior vascular dissection, this appears unchanged. There are no vascular masses identified. The bilateral vertebral arteries are patent with no evidence of stenosis.
1.Nonenhanced MRI of the brain shows no evidence of acute intracranial process and no evidence of acute stroke. Stable foci of encephalomalacia in the posterior aspect of the right insula, anterior/inferior aspect of the right parietal lobe, and posterior/inferior aspect of the right frontal lobe from prior infarction.2.Stable findings of irregularity and mild narrowing of the distal cervical and proximal petrous segments of the right internal carotid - the site of previous dissection.