 The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate-severe chronic small vessel ischemic changes. More focal areas of chronic encephalomalacia is seen along the right frontal parietal region and the right occipital lobe, where there is minimal susceptibility likely representing chronic hemosiderin deposition. Postcontrast images are limited by patient motion. There is no definite pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.There is absence of the right internal carotid artery flow void within the provided field-of-view except for the supraclinoid portion which may be related to collateral flow. However contrast enhancement is noted in the right carotid on the postcontrast images without significant intrinsic T1 hyperintensity. Normal flow-voids are otherwise demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild scattered mucosal thickening in the maxillary sinuses.CERVICAL SPINE
1. No acute infarct. Moderate-severe chronic small vessel ischemic changes, advanced for the patient's stated age, with scattered areas of chronic infarct.2. Nonvisualization of the majority of the right internal carotid artery flow void within the field-of-view except for the very distal vessel, although enhancement is seen on post contrast images suggesting a component of collateral flow and likely chronic more proximal high-grade stenosis or near occlusion of the right internal carotid artery origin. Dedicated imaging of the neck vasculature may be obtained as clinically indicated for comparison may be made to prior outside imaging.3. Motion limited cervical spine exam. Essentially near complete fusion of C4 through C7 with focal likely adjacent level disease at C3-C4 resulting in moderate-severe central spinal canal stenosis as well as severe bilateral foraminal narrowing.