 Brain MRI:Changes of chronic infarction are redemonstrated involving the right MCA territory with encephalomalacia, gliosis, and ex vacuo dilatation of the right lateral ventricle. A small old infarct in the right cerebellum is also again noted. Both are associated with a small amount of hemosiderin staining. There is mild diffuse volume loss without a specific lobar predominant atrophy pattern. There are T2 hyperintense foci within the periventricular and subcortical white matter as well as pons without restricted diffusion or susceptibility abnormality. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Redemonstrated are changes from prior nuclear aeration. Fluid within the mastoid air cells is consistent with the patient's intubated status. Redemonstrated is a 2 cm lipoma of the right paramedian forehead.Brain MRA: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 arterial stenoses, occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Incidental note is made of persistent right fetal PCA circulation.
1.Chronic right cerebellar and right MCA distribution infarctions.2.No acute ischemia.3.Mild chronic small vessel ischemic disease.4.Negative MRA of the brain.