 MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is scattered mild periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a right greater than left maxillary mucosal sinus thickening.MRA Brain: Motion obscures full evaluation of the circle of Willis. Within these limitations, there is moderate atherosclerotic narrowing of the cavernous segment of the left ICA and mild narrowing of the cavernous segment of the right ICA. The remaining intracranial internal, middle and anterior cerebral arteries are patent without significant stenosis. There is no flow related signal within the left vertebral artery likely indicating occlusion. A 2 mm outpouching projecting from the proximal basilar artery could represent the stump of the occluded vertebral artery versus a small aneurysm. The right vertebral artery, basilar artery, and posterior cerebral arteries also are patent without significant stenosis. MRA Neck: The origin of the left vertebral artery is visualized but shortly thereafter the vertebral artery does not opacify likely indicating occlusion. There is minimal if any opacification of the remaining left cervical vertebral artery segments. The right vertebral artery is patent although there is mild luminal irregularity likely secondary to atherosclerotic disease.The common carotid arteries and cervical internal carotid arteries are normal in course and caliber.
1.No evidence of acute intracranial hemorrhage, mass or infarct.2.Likely chronic atherosclerotic occlusion of the left vertebral artery beginning shortly after its origin and extending intracranially.3.2 mm outpouching from the proximal basilar artery could represent either the stump of the occluded V4 segment versus a small aneurysm.4.Scattered areas of atherosclerotic disease involving the remaining arteries of the neck and intracranial circulation without significant flow-limiting stenosis as described above.5.Scattered mild chronic small vessel ischemic disease.