Syncope and collapse, if the source of nonresponsiveness, evaluate for the cause of syncope. There is no evidence of acute infarct. There is encephalomalacia along the watershed zone between the right anterior and middle cerebral artery territory extending to the centrum semiovale with ex vacuo dilatation of the right lateral ventricle and right-sided cortical sulci. There are patchy and scattered foci of cerebral white matter T2 hyperintensity which are nonspecific, mostly related to chronic small vessel ischemic changes. There is gyriform susceptibility effect involving the right posterior parietal lobe likely related to chronic microhemorrhage. The ventricles and basal cisterns are unchanged, with evidence of diffuse cerebral volume loss. There is no midline shift or herniation. The right internal carotid artery flow void is lacking proximally, with reconstitution of the flow voids at the petrous and cavernous portion, with heterogeneous flow void signal, which may relate to slow flow. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Chronic infarction involving the right frontal and parietal lobes in a watershed distribution, as well as a background of probable chronic small vessel ischemic changes.2. Redemonstration of occlusion of the proximal intracranial right internal carotid artery. 