Arachnoid cyst and EtOH abuse, now with unprovoked dizziness while driving. There is an unchanged arachnoid cyst overlying the left anterior temporal lobe, inferior left frontal lobe, and insula, with mass effect upon the underlying brain parenchyma. There are mild scattered foci of cerebral white matter T2 hyperintensity and a small area of encephalomalacia in the left basal ganglia. There is no evidence of acute infarct. There is no midline shift or herniation. The left internal carotid artery flow void is diminutive. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral lens implants.
1. Unchanged arachnoid cyst overlying the left anterior temporal lobe, inferior left frontal lobe, and insula, with mass effect upon the underlying brain parenchyma. 2. Mild scattered foci of cerebral white matter T2 hyperintensity. 3. Probable chronic small vessel ischemic disease and chronic left basal ganglia chronic infarct, but no evidence of acute infarct.4. The left internal carotid artery flow void is diminutive, which could indicate proximal stenosis. Dedicated neurovascular imaging of the head and neck may be useful for further evaluation.