left side weakness There are multifocal restricted diffusion lesions on the right side basal ganglia extending toward posterior aspect of internal capsule and right periventricular white matter, left periventricular white matter and right cerebellar hemisphere. Since the right cerebellar hemispheric lesions show minimal restriction, these lesions could represent relatively older lesions.There is no evidence of acute hemorrhagic lesion on this scan.Underlying brain shows multifocal high patchy high signal intensity lesions on FLAIR images on bilateral centrum semiovale and periventricular white matter indicating non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses 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 multifocal intracranial arterial luminal irregularities and narrowings involving right MCA M1 and M2 segments, bilateral ACA A2 segments. The right vertebral artery is hypoplastic. Bilateral PCAs are fetal origin.Acom artery appears to be patent.There is no major branch occlusion or evidence of intracranial arterial aneurysm.3D MRA neck TOF images with maximum intensity projections show normal bilateral carotid bifurcations and normal appearance of bilateral extracranial internal carotid arteries. The right vertebral artery appears to be hypoplastic and the left vertebral artery is dominant.Due to technical limitation, the aortic arch vessels especially origins of each vessels including bilateral vertebral arterial ostia cannot be evaluated.
1. Multifocal various aged acute ischemic infarctions without evidence of hemorrhagic transformation as described above.2. Underlying non specific small vessel ischemic disease.3. Multifocal various degreed intracranial arterial luminal narrowings indicating intracranial atherosclerosis.4. No evidence of significant luminal narrowing or irregularity on extracranial craniocervical arteries. 