 BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered areas of periventricular and subcortical white matter FLAIR signal abnormality are consistent with age indeterminate small vessel ischemic disease. There is an old lacunar infarct in the right cerebellar hemisphere. Global parenchymal volume loss appears commensurate for the patient's age. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.MRA HEAD: The exam is significantly degraded by motion artifact. There is an apparent protrusion of the left cavernous ICA and slight prominence of the vasculature at the right MCA bifurcation. The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The left vertebral artery is dominant. The basilar artery and posterior cerebral arteries are normal in course and caliber. The posterior communicating arteries are not definitely visualized. There is no evidence of flow-limiting stenosis.
1. Chronic small vessel ischemic disease. No evidence of acute infarct.2. Apparent protrusion of the left cavernous ICA and slight prominence of the vasculature at the right MCA bifurcation may be artifactual or related to atherosclerotic irregularity, although aneurysmal dilatation cannot be excluded. If further imaging is clinically indicated, CTA may provide more reliable information. 