 This exam is degraded by motion artifact.BRAIN: There is an unchanged right frontal lobe chronic infarct with resultant encephalomalacia and volume loss including Wallerian degeneration of the right cerebral peduncle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. MRA HEAD: There is unchanged severe stenosis of the distal right internal carotid artery with only residual string like flow related signal. There is also further interval reduction in the flow related signal within the arteries throughout the right middle cerebral artery territory. There are unchanged linear foci of flow related signal located at the right internal carotid artery bifurcation compatible with collateral vessels. The left intracranial internal carotid artery is normal in course and caliber. The left middle and bilateral anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of aneurysm.MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is unchanged severe stenosis of the right common and internal carotid arteries with only minimal residual string like flow related signal. There are also unchanged multifocal moderate stenosis (up to 50%) of the right brachiocephalic artery with post-stenotic dilatation of the right subclavian artery. There are also moderate stenoses involving the left common carotid and left subclavian artery origins. The remainder of the left common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent.
1.Unchanged right frontal lobe MCA distribution chronic infarction.2.Unchanged severe stenosis involving the entire course of the right common and internal carotid arteries with demonstration of string like lumen continued from the level of common carotid artery to the level of supraclinoid segment of the ICA.3.Further interval decrease in anterograde blood flow throughout the right middle cerebral artery distribution although collateral perfusion (centripetal) direction flow) cannot be assessed on this exam using TOF technique. MR perfusion would be helpful on follow-up imaging to assess for changes in blood flow between the two hemispheres. 4.Unchanged moderate relatively long segment stenoses of the brachiocephalic, left common carotid, and left subclavian artery origins, with poststenotic dilatation of the right subclavian artery.