Male, 81 years old, with dizziness and nausea and emesis. Assess for posterior circulation stroke or stenosis. Patchy, nearly confluent periventricular T2 hyperintensity is again seen, similar to the prior examination. New from the prior study is T2 hyperintensity and volume loss affecting the left cerebellar hemisphere and left middle cerebellar peduncle. Scattered focal T2 hyperintense lesions are also evident within the bilateral basal ganglia, the pons, and elsewhere throughout the cerebellum.No evidence of restricted diffusion is seen. No frank parenchymal edema or mass-effect is detected. No evidence of intracranial hemorrhage is seen. The ventricles are prominent, similar to prior, and compatible with volume loss.MRA images reveal mild to moderate vascular narrowing of the cavernous ICAs. More distally, there are scattered mild to moderate focal and segmental stenoses throughout the ACA, MCA and PCA distributions. The vertebral arteries and basilar artery do, however, remain patent. The smaller vertebro-basilar branches are not well visualized beyond their origins which can be related to technique. No aneurysms are detected within the limitations of technique.
1.No evidence of acute ischemia or any other acute intracranial abnormality.2.Extensive chronic small vessel and lacunar ischemic disease, largely unchanged from the prior examination.3.Encephalomalacia involving the left cerebellar hemisphere is new from the prior MRI and most likely represents chronic ischemic injury.4.MRA images reveal numerous scattered focal and segmental stenoses throughout all vascular distributions. The vertebral arteries and the basilar artery do, however, remain patent. Small vertebro-basilar branches are not well visualized, likely due to technique, which prevents accurate assessment for steno-occlusive disease.