Syncope, neurologic deficits, and difficulty performing calculations. Possible prior TIA. MRI brain:No foci of restricted diffusion to indicate acute ischemia. Scattered foci of periventricular and subcortical white matter increased T2 signal are compatible with chronic small vessel ischemic disease which is stable to minimally progressed compared to prior. Small area of focal encephalomalacia in the posterior right frontal lobe compatible with a chronic infarct. There are a few scattered foci of susceptibility in the posterior fossa compatible with prior microhemorrhages.There is no evidence of intracranial mass or edema. Stable prominence of the CSF spaces in the posterior fossa which may be related to mega cisterna magna or small arachnoid cyst. The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present.Mild mucosal thickening involving the paranasal sinuses. Partial opacification of the left mastoid air cells. MRA head and neck:No significant stenotic disease in the neck. Conventional arch anatomy. The carotid and right vertebral artery origins are widely patent. The origin of the left vertebral artery is poorly visualized, likely due to artifact as the vessel immediately develops a normal caliber. No evidence of dissection.Intracranial carotid arteries are also widely patent. Minimal atherosclerotic changes are seen without significant stenosis in the anterior or posterior circulation. Diminutive/absent bilateral PCOM arteries. Codominant vertebrobasilar system. No intracranial aneurysms.
1. No evidence of acute infarct.2. Mild to moderate chronic small vessel ischemic changes are stable to minimally progressed compared to prior from 2012.3. No significant stenosis in the intracranial vasculature or extracranial vasculature in the neck.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.