 The study is slightly degraded by motion.MRI BRAIN:There is no convincing restricted diffusion. There are scattered T2/FLAIR hyperintensities in the subcortical and periventricular white matter and in the centrum semiovale, most likely representing chronic ischemic vascular changes. A small chronic infarct is seen in the right cerebellum. There is volume loss with prominence of the ventricles and sulci. There is no midline shift. Basal cisterns are patent. There are tiny susceptibility foci dispersed throughout the white matter and a susceptibility focus in the right basal ganglia, representing old blood products from previous hemorrhage versus mineralization.MRA BRAIN:MRA image quality is significantly reduced by motion artifact. Within this limitation, the following observations are made.The internal carotid arteries are patent with atherosclerotic irregularities seen in the cavernous segments and the supraclinoid segments. The anterior cerebral arteries are patent with slight asymmetry of the A1 segments, right smaller than left. There may be mild narrowing of the right M1 middle cerebral arteries but this is equivocal. The right PCA is not visualized. The left PCA is patent.The right vertebral artery distal to the origin of the right PICA is not visualized. The visualized left vertebral artery and basilar artery are patent. The posterior communicating artery bilaterally are not visualized.
1. No evidence for acute intracranial hemorrhage, mass effect, or edema. There is no convincing evidence of acute ischemia.2. Chronic subcortical and periventricular white matter vascular ischemic changes with a small chronic infarct in the right cerebellum. 3. The right posterior cerebral artery is not visualized and may be occluded.4. The distal right vertebral artery, distal to the origin of the right PICA is also not visualized and may be occluded.