Stroke. MRI: There are right posterior frontal lobe subcortical white matter T2 hyperintense foci, between the superior and frontal gyri in a linear distribution. There are prominent perivascular spaces in the bilateral basal ganglia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is nonspecific left tympanomastoid fluid. There is a small left maxillary sinus retention cyst.Brain MRA: There is a focal high-grade stenosis of the distal M1 segment of the right middle cerebral artery. There is mild decrease in caliber of the left vertebral artery after the origin of the left PICA. The other major cerebral artery flow voids are intact. There is no evidence of cerebral saccular aneurysms.Neck MRA: There is no evidence of significant steno-occlusive lesions.
Right posterior frontal lobe subcortical white matter T2 hyperintense foci, between the superior and frontal gyri in a linear distribution are suggestive of chronic watershed ischemia, perhaps related to the high-grade stenosis of the distal M1 segment of the right middle cerebral artery. Otherwise, no evidence of acute infarction or hemorrhage and no significant steno-occlusive lesions in the cervical arteries.