 MRI BRAIN: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2 hyperintensity within the periventricular and subcortical white matter. There is encephalomalacia in the right occipital lobe, right corona radiata, right cerebellar hemisphere, left pons, and bilateral thalami. There are scattered punctate foci of susceptibility effect, consistent with hemosiderin deposition. There is T1 hyperintense signal within the right centrum semiovale and medial right basal ganglia, which may be due to mineral deposition. There is a small enhancing focus in the left medial thalamus, which is likely related to a small developmental venous anomaly. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a faintly enhancing extra-axial hypointense mass along the left frontal convexity without significant mass effect upon the adjacent brain parenchyma. The skull and extracranial soft tissues are otherwise unremarkable.  MRA HEAD: There is irregularity of the circle of Willis, particularly the bilateral cavernous internal carotid arteries and the mid basilar artery. The intracranial internal carotid arteries, middle and anterior cerebral arteries are otherwise patent. The right vertebral artery and posterior cerebral arteries are patent. The left vertebral artery is diminutive, which may be an anatomic variant. There is no evidence of aneurysm. MRA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are patent. The left vertebral artery is diminutive, which may be an anatomic variant. There is otherwise no evidence of flow-limiting stenosis or occlusion.
1. Chronic right occipital lobe, right corona radiata, right cerebellar hemisphere, left pons, and bilateral thalami infarcts superimposed upon a background of probable chronic small vessel ischemic disease, but no evidence of acute infarct.2. Irregularity of the circle of Willis, particularly the bilateral cavernous internal carotid arteries and the mid basilar artery, is likely related to atherosclerosis. 3. Diminutive left vertebral artery diffusely, but otherwise patent cervical arteries.4. A small faintly enhancing extra-axial hypointense mass along the left frontal convexity may represent a meningioma.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.