 MRI Brain:This is a motion degraded exam. Redemonstrated is an evolving subacute infarct within the left basal ganglia, left caudate, left thalamus, and left temporal lobe with overlying susceptibility abnormality compatible with mild hemorrhagic transformation, which appears similar to the previous exam. There is associated T2/FLAIR signal abnormality in this region and there is unchanged mass effect on the adjacent frontal horn of the left lateral ventricle. There is also an acute infarct involving the left periatrial white matter which was also present on recent prior exams. There are chronic right cerebellar infarcts. There is additional superimposed mild periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to small vessel ischemic disease. There is diffuse volume loss. The ventricles and basal cisterns are otherwise unchanged. 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 Brain: Exam is severely limited by motion artifact. Within these limitations, there is no visible high-grade stenosis involving the intracranial ICAs, MCA's or ACAs bilaterally. The right vertebral artery is diminutive which may be related to stenosis and or hypoplasia. The left PCA is asymmetrically diminutive compared to the right. The left vertebral, basilar, and right posterior cerebral arteries are patent with no significant stenosis.
1.Continued evolution of a subacute infarct involving the left basal ganglia, left caudate nucleus, left thalamus, and left temporal lobe with mild hemorrhagic transformation and with unchanged mass effect on the frontal horn of left lateral ventricle.2.Evolving acute/subacute infarct in the left periatrial white matter which was also present previously.3.Mild chronic small vessel ischemic disease.4.Within the limitations of motion degradation on the MRA brain, there is a diminutive right V4 which may be related to stenosis and/or hypoplasia and the left PCA is also asymmetrically diminutive compared to the right. Remainder of the major intracranial vasculature is grossly patent.