Altered mental status. There is no evidence of acute ischemic lesion on the scan.A couple of focal susceptibility lesions on on the left high frontal and right occipital lobe on gradient echo images indicating chronic microscopic hemorrhagic lesions.Patch high signal intensity lesions on bilateral periventricular white matter and centrum semiovale on FLAIR images indicate nonspecific small vessel ischemic disease. There is a large perivascular space visualized on the left inferior aspect of basal ganglia which is normal finding.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses except frontal sinus which had prior surgery and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.Although limited noncontrast enhanced MRA neck images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.2. Extensive nonspecific small vessel disease.3. Normal intracranial MRA.4. No evidence of significant luminal stenosis on neck MRA. If clinically indicated, CTA of the neck can be considered for further imaging evaluation.