Syncope. The study was initially protocoled along with MRA of the neck with contrast. However, the patient was unable to hold still for the examination despite premedication. Therefore, no contrast was given and the contrast-enhanced neck MRA was not performed. The study remains at least moderately limited by patient motion.Brain MRI: There is wedge shaped diffusion restriction involving the anterior-superior aspect of the left cerebellar hemisphere, associated with T2-hyperintense/T1-hypointense signal and mild swelling but no significant mass-effect on the fourth ventricle or other posterior fossa structures. This is compatible with an acute/early subacute infarct. There is T2-hyperintensity with volume loss in the left pons, compatible with encephalomalacia, most probably from previous infarct. There is moderate patchy T2-hyperintense signal in the cerebral white-matter as well, which probably represents chronic microvascular ischemia. There are multiple foci of susceptibility effect involving the right basal ganglia, compatible with punctate hemorrhages. There is no definite associated edema or T1 shortening. In fact, these are associated with mild but focal ex vacuo enlargement of the posterior body on the right lateral ventricle. Otherwise, there is moderate global brain volume loss resulting in expansion of the ventricles and other CSF-containing spaces. There is no midline shift or brain herniation. The sella is expanded and largely fluid-filled.The mastoid air cells are clear. There is trace mucosal thickening in the paranasal sinuses. There is no gross orbital abnormality. A small forehead lesion that is T1-hyperintense may represent a small sebaceous cyst.SusceptibilityCranial MRA:There is moderate irregularity and attenuation of flow-related signal in the right V4 segment, which probably reflects moderate atherosclerosis. The left vertebral artery and the basilar artery are patent but slightly irregular. Similarly, the other major intracranial vessels show irregularity likely related to atherosclerotic disease without large vessel occlusion. Note motion degradation limits assessment.
1.Examination moderately limited by motion.2.Acute/early subacute left cerebellar infarct, in the territory of the superior cerebellar artery.3.Chronic left pontine infarct and moderate cerebral chronic microvascular ischemia. Moderate brain volume loss.4.Punctate hemorrhages in the right cerebral hemisphere are likely chronic and may relate to hypertension.5.Diffuse moderate atherosclerosis of the intradural segment of the right vertebral artery. There is also atherosclerotic involvement of the other major intracranial vessels but no large vessel occlusion.