Aphasia. Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There is moderate patchy cerebral white matter T2 hyperintensity. There is a subcentimeter lesion within the right internal auditory canal. There is a punctate focus of susceptibility effect in the left cerebellar hemisphere, which may represent a chronic microhemorrhage. There is diffuse prominence of the sulci and ventricles due to cerebral volume loss. There is cavum septum pellucidum and vergae, which represents an anatomic variant. There is no midline shift or herniation. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions or retention cyst formation in the right maxillary sinus. Brain MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.Neck MRA: There is a two vessel aortic arch, in which the left common carotid artery arises from the brachiocephalic trunk, which is an anatomic variant. The ascending aorta appears to be enlarged, measuring at least 4.5 cm in width. There is no evidence of significant steno-occlusive lesions in the neck.
1. Probable chronic small vessel ischemic disease and diffuse cerebral volume loss, but no evidence of acute intracranial hemorrhage or acute infarct.2. An incompletely characterized subcentimeter right internal auditory canal lesion may represent a schwannoma.3. No evidence of significant steno-occlusive arterial lesions in the head or neck.4. The ascending aorta appears to be enlarged, measuring at least 4.5 cm in width.