 MRI Brain:Redemonstrated is extensive cystic encephalomalacia involving most of the right frontal lobe, right superior and middle temporal gyri, and extending into the right parietoccipital fissure. There is associated right-sided Wallerian degeneration and ex vacuo dilatation of the right lateral ventricle. There is also some scattered susceptibility abnormality in a curvilinear gyriform pattern more posteriorly in the region of old infarct on the right. Additional periventricular and subcortical FLAIR hyperintensities are noted consistent with chronic small vessel ischemic changes. There is no evidence of acute intracranial hemorrhage, mass effect, midline shift, herniation, hydrocephalus or extra-axial fluid collection. Again seen is edema within the right superior periorbital soft tissues which is unchanged.MRA Brain: Exam is limited by motion artifact. There is asymmetric decreased caliber of the right ICA, MCA and ACA, with only a few right MCA branches visualized. The left MCA and ACA are patent. The AComA and right PComA are not visualized. The distal right PCA is slightly decreased in caliber, while the left PCA is within normal limits. There is chronic severe stenosis of the more proximal cervical right vertebral artery with the distal right V4 segment possibly partially retrograde opacified from the basilar artery to the mid right V4 segment near the expected location of the PICA origin. Evaluation of right PICA and AICA are limited secondary to the motion artifact.MRA Neck: Motion artifact is present. There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. There is focal narrowing of the origin of the distal right carotid bulb which could be artifactual, with asymmetric decreased caliber of the right ICA as it extends intracranially given the chronic right-sided infarct. There is mild eccentric plaque along the proximal left carotid bulb. The common carotid arteries and left cervical internal carotid artery are otherwise normal in course and caliber.The right vertebral artery is is not well visualized at its origin along the right proximal V1 segment. Thready contrast opacification is identified throughout the cervical right vertebral artery, although evaluation is limited secondary to motion artifact and likely surrounding mild venous contamination. There is significant irregularity of the proximal to mid right V4 segments with improved visualization following apparent PICA origin.
1.No evidence of an acute infarct.2.Extensive encephalomalacia of the right MCA and ACA territories, with underlying mild-moderate chronic small vessel ischemic disease and associated diminutive caliber of right anterior circulation vessels.3.Severe stenosis of the right vertebral artery origin and the proximal right V1 segment is not well visualized, although the remainder of the vessel is seen but thready, with more focal areas of narrowing intracranially. It is difficult to determine if there is collateral vascular supply to the vessel given the extensive artifact.4.No other significant extracranial vascular stenosis, although evaluation is significantly limited due to extensive motion artifact.