 MRI BRAIN: No definite diffusion weighted abnormalities are appreciated. Foci of abnormal signal on DWI in the midbrain are felt to reflect a combination of T2 shine through and artifact without corresponding low ADC signal. There is a moderate degree of periventricular and subcortical punctate and patchy hyperintense white matter lesions present identified on the FLAIR and T2 images. Small focus of encephalomalacia in the peripheral left cerebellar hemisphere. There are unchanged foci susceptibility in the right thalamus, central and left mid brain, and periventricular white matter.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal flow-voids are demonstrated in the major intracranial vascular structures.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA HEAD: Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.There is redemonstration of approximately 60% stenosis involving the left inferior division M2 MCA segment. There is also mild narrowing of the distal right vertebral artery at the junction with the left vertebral artery. Note is made of an extracranial origin of the right PICA. The superior cerebellar arteries originate from the PCAs. MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion.Both vertebral artery origins are patent. The left vertebral artery is dominant. Suboptimal evaluation of the origins of the vertebral arteries.
1. There is no evidence for acute ischemic cerebral infarction or hemorrhage.2. Periventricular and subcortical white matter lesions of a moderate degree are nonspecific. At this age they are most likely vascular related. 3. Multiple microhemorrhages in the midbrain, right thalamus, and periventricular white matter. This was also present on the 9/2016 exam.4. Small focus of encephalomalacia in the left peripheral cerebellar hemisphere.5. There is no evidence for extracranial cerebrovascular occlusive disease.6. Approximately 60% stenosis involving the inferior division M2 segment of the left middle cerebral artery. This is stable