 Brain MRI:There is no restricted diffusion on diffusion weighted images to indicate an infarct. No susceptibility weighted abnormalities to indicate intracranial hemorrhage. Note is made of very mild periventricular and subcortical white matter T2/Flair signal abnormalities which is nonspecific but compatible with very mild chronic small vessel ischemic changes.There is advanced global parenchymal volume loss commensurate with age. The ventricles are somewhat prominent compared to the sulci. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There are no extraaxial fluid collections or subdural hematomas. Mild right maxillary and ethmoid opacification. The paranasal sinuses and mastoid air cells are otherwise clear. Mild degenerative changes are noted of the visualized upper cervical spine.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. There is some narrowing of the left M2/M3 segments which may be due to atherosclerotic disease. No arterial occlusions or aneurysms are identified. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. There is a left dominant vertebral artery. A small left A1 segment and small left PICA is noted.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or at the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. The left vertebral artery is tortuous within the neck but there is no stenosis.
1. No evidence of acute infarct.2. Global parenchymal volume loss commensurate with patient's age. There is slight prominence of the ventricles compared to the degree of volume loss raising question of communicating hydrocephalus/NPH in the appropriate clinical setting. No significant change since 8/5/2010. 3. No significant steno-occlusive disease of the arteries of the brain or neck. 