 There is no diffusion abnormality to suggest acute infarct. Again seen are areas of encephalomalacia/gliosis in the left MCA territory primarily involving the left frontal lobe likely related to prior ischemic injury. Additional area of FLAIR hyperintensity is seen more diffusely involving the bilateral periventricular and subcortical white matter. Small focus of T2 hyperintensity likely representing a lacunar infarct involving the right caudate head is again seen. There are multiple areas of nonsuppression of CSF on the FLAIR sequence consistent with subarachnoid hemorrhage. These are predominantly peripheral in distribution There is mild ex vacuo dilatation of the left lateral ventricle. Diminished size of the left cerebral peduncles compatible with Wallerian degeneration along the corticospinal tracts. Again seen is vertebral artery coursing along the surface of the medulla with contour deformity of the medulla, finding which is of doubtful clinical significance.No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. Small right maxillary mucus retention cyst. Diffuse low T1 marrow signal is nonspecific and can be seen with conditions such as chronic anemias.MRA HEAD
1. Again seen is subarachnoid hemorrhage predominately in a peripheral distribution similar to recent CT. No evidence of acute infarct, intracranial mass, or mass effect.2. Extensive encephalomalacia involving the left frontal lobe cortex is again seen consistent with chronic infarct. Additional bilateral areas of FLAIR hyperintensity in the periventricular white matter, which while nonspecific is also favored to be vascular in etiology and not significantly changed. Chronic lacunar infarct in the right caudate head also again seen and not significantly changed since prior exam from 11/6/2013.3. Intracranial vasculature demonstrates areas of ectasia, such as at proximal right A2 and beyond the left MCA bifurcation involving the superior division, without discrete aneurysm. No high-grade stenosis is demonstrated in the intracranial vasculature.4. MR venogram without contrast is technically degraded. Major venous structures are better evaluated on recent CTA from 5/22/2015 and appear patent.