 The examination is limited by motion artifact. There is a large area of ischemia involving the left PICA territory, specifically the left lateral medulla and left cerebellar hemisphere. Small areas of ischemia are also present in the right cerebellum. There is ischemia involving the red nucleus of the right midbrain as well as a punctate area of ischemia in the left pons. Symmetric appearing areas of ischemia are demonstrated in the bilateral occipital lobes. Punctate foci of ischemia are demonstrated in the right frontal lobe and left parietal lobe. There is global volume loss with scattered lacunar infarcts present in the bilateral basal ganglia and periventricular white matter. There is no evidence for hydrocephalus. Scattered punctate areas of susceptibility are demonstrated however there is no evidence for hemorrhagic transformation in the areas of infarction. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. There is scattered paranasal sinus disease with ethmoid mucosal thickening and air-fluid levels present in the left maxillary sinus and right sphenoid sinus.MRA HEAD
Limited examination secondary to motion artifact.1. Multifocal areas of ischemia involving the anterior and posterior circulation with largest area involving the left PICA territory. Additional smaller areas of ischemia are demonstrated in the right cerebellum, bilateral brainstem, bilateral occipital lobes, posterior right frontal lobe, and left parietal lobe.2. There is high-grade stenosis or occlusion of the distal left vertebral artery with nonvisualization of the left PICA.3. Mild to moderate multifocal areas of atherosclerotic disease involving the intracranial vasculature, most prominent involving the bilateral cavernous internal carotid arteries.4. Global volume loss and scattered white matter and basal ganglia lacunar infarcts likely related to chronic microvascular ischemic disease.5. There is scattered paranasal sinus disease with ethmoid mucosal thickening and air-fluid levels present in the left maxillary sinus and right sphenoid sinus.