 Study is degraded due to motion.MRI BRAIN: There is mild gyriform right parietal-temporal-occipital diffusion hyperintensity with ADC isointensity, also extending to involve the insular cortex. There is corresponding intrinsic T1 hyperintensity along the cortex, suggestive of laminar necrosis. There is associated FLAIR hyperintensity, which also involves the white matter. Other patch areas of T2/FLAIR hyperintensity is present elsewhere in the subcortical and periventricular white matter, especially involving the right greater than left the frontal lobes.Ventricles and sulci are prominent, suggestive of general volume loss, which is much more than the expected for the patient's age. In addition, there is focal volume loss in the right frontal lobe and in the left temporal-occipital lobe from old infarcts with associated ex vacuo dilatation of the adjacent lateral ventricle. There are deep left cerebellar white matter lacunar infarcts.Foci of punctate susceptibility are noted in the right thalamus, most likely due to chronic hemosiderin from previous microhemorrhage. The right red nucleus also demonstrates mild increased susceptibility, perhaps relating to greater iron deposition.MRA BRAIN:The left MCA is not visualized.There is small triangular-shaped outpouching at the origin of the proximal left A1 segment, which may represent a tiny infundibulum versus aneurysm. Incidentally noted, a small vessel arises from the posterior margin of the vessel at this level, along an expected course of the anterior choroidal artery as it is posteriorly directed, but it is difficult to determine if the proximal aspect of the tiny vessel is tortuous and perhaps arising anteriorly prior to coursing posteriorly.There are mild irregularities of the proximal right A1, the distal right M1 and more diffusely involving the more distal right MCA segments, with areas of focal narrowing suggested at the M1 bifurcation.There is a hypoplastic left P1 with fetal origin of the left PCA.There is mild irregularity of the mid to distal right P2 and of the distal left P2.The right proximal V4 is not visualized. The right V4 just proximal to the PICA origin has a normal caliber, with moderate focal narrowing shortly after the PICA origin, and the very distal right V4 is not visualized.There are mild irregularities of the proximal to mid basilar artery.MRA NECK:Evaluation is limited due to lack of contrast. There is poor flow related enhancement of the entire right vertebral artery although the origin is visualized and is patent. The carotid vessels and cervical left vertebral artery are unremarkable.
1. Right parietal, temporal, and occipital laminar necrosis with mild diffusion hyperintensity and ADC isointensity, suggesting evolving late subacute infarct.2. Underlying moderate chronic small vessel ischemic changes with scattered chronic infarcts.3. The left middle cerebral artery is likely chronically occluded.4. Tiny outpouching involving the origin of the left A1 segment, favored to represent an infundibulum although a tiny aneurysm is not entirely excluded. CTA head could be obtained for further evaluation.5. The right cervical vertebral artery is not well visualized likely with slow flow, as there are significant irregularities and discontinuous nonvisualization of the right V4 segment. Origin of the vessel is visualized and appears patent.6. Atherosclerotic irregularities of other intracranial vessels to a lesser degree, as detailed above.