67-year-old male with vertebrobasilar dilatation and previous posterior circulation infarct experienced sudden left hearing loss and a hoarse voice. Brain MRI:There are no foci of restricted diffusion to suggest the presence of acute ischemia. Redemonstrated are changes from an old large left PCA hemorrhagic stroke involving the medial aspect of the left temporal lobe and extending posteriorly to partially involve the occipital lobe. A small old stroke in the distribution of left PCA in the left thalamus is also again noted. A small focus of encephalomalacia within the pons is secondary to expected evolution of a previously identified pontine infarct. Redemonstrated are foci of T2 hyperintensity within the white matter without restricted diffusion. There is no evidence of acute intracranial hemorrhage, mass effect, midline shift or hydrocephalus. Mildly dilated lateral ventricles are secondary to parenchymal volume loss and are unchanged in appearance. The paranasal sinuses and mastoid air cells are clear.Brain MRA:Dolichoectasia of vertebrobasilar system with proximal eccentric plaque and fusiform aneurysmal dilatation of the basilar artery is present, not significantly changed in appearance given differences in technique.Redemonstrated is lack of flow within the distal right vertebral artery, although flow within right PICA is maintained.There is loss of flow within left PCA. Otherwise, there is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No other arterial stenoses, occlusions, arteriovenous malformations, or aneurysms are identified.
1.No acute ischemia.2.Stable large old minimally hemorrhagic left PCA stroke along its entire distribution as described with commensurate loss of flow in the left PCA.3.Mild chronic small vessel ischemic disease.4.Occluded intracranial right vertebral artery as was noted on prior CTA.5.Dolichoectasia of vertebrobasilar system with proximal eccentric plaque and fusiform aneurysmal dilatation of the basilar artery is present, not significantly changed in appearance given differences in technique.