 MRI brain:Numerous scattered foci of restricted diffusion are present in both cerebral hemispheres and left middle cerebellar peduncle, most of which are associated with increased FLAIR signal. There are at least 2 small foci of foci of abnormal enhancement noted in the region of the anterior limb of the left internal capsule and head of the right caudate nucleus, where foci of diffusion restriction were noted on the prior MRI and therefore felt to represent subacute infarcts. The subacute infarct in the anterior limb of the left internal capsule also corresponds to a area of subtle intrinsic T1 hyperintensity and susceptibility artifact likely representing minimal hemorrhage or mineralization.Hypointense T1 and hyperintense T2/FLAIR signal in the pons, periventricular and subcortical white matter is nonspecific, but most likely related to chronic small vessel ischemic change. The ventricles and sulci are prominent, in keeping with generalized cerebral volume loss. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are otherwise within normal limits. Fluid signal with air-fluid levels are present in the bilateral sphenoid sinus and left maxillary sinus. MRA brain:The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and right posterior cerebral arteries are normal in course and caliber. There is moderate to severe focal narrowing of the mid left P2 segment. There is no evidence of flow-limiting stenosis or aneurysm.
1. Increased number of punctate foci of abnormal signal and/or diffusion restriction in the cerebral hemispheres and left middle cerebellar peduncle likely related to embolic infarcts of multiple ages (overall acute to subacute), given patient history. No evidence of significant hemorrhagic conversion or mass effect.2. Abnormal signal in the periventricular and subcortical white matter is nonspecific, but likely related to moderate chronic small vessel ischemic changes.3. No evidence of occlusion or aneurysm in the major intracerebral arteries. Moderate to severe focal narrowing at the mid left P2 segment.