 MRI head: There is no definite evidence of acute ischemia. There are punctate foci of diffusion hyperintensity involving the right thalamus as well as the left occipital lobe with adjacent foci of chronic microhemorrhage. These foci of chronic microhemorrhages were present on prior study from 4/14/2014. Multiple small foci of T2 hyperintensity involving the bilateral thalami are unchanged. Confluent and patchy T2/FLAIR hyperintensities in the periventricular and subcortical white matter as well as in the pons are compatible with chronic small vessel ischemic disease and are again seen. There is no evidence of intracranial mass effect, midline shift, or herniation. Ventricular size is normal. There is moderate supratentorial and infratentorial volume loss similar to prior.Again seen are multiple punctate foci of susceptibility related to chronic microhemorrhages including the bilateral basal ganglia and thalami as well as in the pons similar to prior. Relatively larger focus of chronic hemorrhage along the left lateral ventricle is also unchanged. Additional scattered foci of susceptibility in the cerebral hemispheres are also not significantly changed. There is a mucous retention cyst in the right maxillary sinus.MRA brain: There are mild atherosclerotic changes in the intracranial circulation without significant stenosis. The intracranial internal carotid arteries are patent. The anterior, the middle, and posterior cerebral arteries are patent. The basilar and vertebral arteries are patent. There is no flow-limiting stenosis or aneurysm.MRA neck: The common carotid arteries, the cervical internal carotid arteries, and the vertebral arteries are patent with no evidence of aneurysm or flow-limiting stenosis. There is common origin of the brachiocephalic artery and the left common carotid artery, which is a normal variant.
1. No definite evidence of acute ischemia. There are punctate foci of diffusion hyperintensity in the right thalamus as well as in the left occipital lobe immediately adjacent to chronic microhemorrhages. These are suspected to be artifactual given absence of new T2 hyperintensity within this region, although acute ischemia, particularly in the right thalamus is not entirely excluded.2. Chronic small vessel ischemic disease with multiple lacunar infarcts and multiple microhemorrhages, which are predominantly in a distribution favoring chronic hypertension, appear similar to prior.3. The MRA of the brain and neck demonstrates no evidence of flow-limiting stenosis.