Aphasia, right sided weakness. MRI: There is encephalomalacia and susceptibility effect in the inferior left parietal lobe. There is also gyriform susceptibility effect and punctate subcortical susceptibility effect in the left occipital lobe. There is a background of diffuse cerebral white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute infarct. There is diffuse mild cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRA: There is no evidence of significant steno-occlusive lesions in the major head and neck arteries. There is a three vessel aortic arch. The bilateral vertebral arteries are tortuous and the left vertebral artery is diminutive diffusely. There is no evidence of cerebral aneurysms. There is a fetal left posterior cerebral artery, which represents an anatomic variant.
1. No evidence of acute acute infarct. Encephalomalacia and susceptibility effect in the inferior left parietal lobe, as gyriform susceptibility effect and punctate subcortical susceptibility effect in the left occipital lobe may represent prior hemorrhages, perhaps related to amyloid angiopathy.2. No evidence of significant steno-occlusive lesions in the major head and neck arteries. 