Bilateral carotid stenosis and episodes of spacing out for 3-5 min. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a punctate focus of encephalomalacia in the left thalamus and a small area of encephalomalacia in the right parietal lobe. There is diffuse patchy cerebral and pontine white matter T2 hyperintensity. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The bilateral cavernous internal carotid artery flow voids are diminished. There also appears to be focal stenosis of the left intracranial vertebral artery. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.
1. Chronic infarcts in the right parietal lobe and left thalamus, as well as probable chronic small vessel ischemia, but no evidence of acute infarct. 2. Steno-occlusive disease involve ing the carotid arteries and a small left PICA aneurysm are better depicted on the recent CTA.