 BRAIN: There is no abnormal diffusion weighted signal to suggest acute ischemic infarction. Mild prominence of the cortical sulci and supratentorial ventricles is compatible with age-related volume loss appearing similar to prior. There is no midline shift or herniation. Scattered punctate foci of increased T2/FLAIR signal within the supratentorial white matter are compatible with chronic small vessel ischemic changes appearing similar to the 10/17/2012 exam. There is a 6 x 6 mm intraparenchymal focus of signal abnormality adjacent to the left hippocampal head which demonstrates internal T2 hyperintensity and T1 hypointensity without associated edema or mass effect appearing similar to the prior examination. Scattered punctate foci of decreased signal on susceptibility weighted images are present within the bilateral cerebral and cerebellar hemispheres appearing similar to prior. There is once again a chronic blowout fracture left lamina papyracea. Postcontrast images do not demonstrate any abnormal areas of intraparenchymal enhancement.MRA HEAD: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The right P1 is hypoplastic. The left PCOM is poorly visualized. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or 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 are normal in course and caliber. There is a short segment of approximately 30% stenosis involving the origin of the right internal carotid artery. The left internal carotid artery is normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of flow-limiting stenosis or occlusion.
1.No acute ischemic infarction. 2.Mild age-related volume loss and chronic small vessel ischemic disease, unchanged.3.MRA of the head and neck without aneurysms or flow-limiting stenosis. Mild (approximately 30%) narrowing of the origin of the right internal carotid artery.4.Redemonstration of a 6 mm focal signal abnormality adjacent to the left hippocampal head which likely represents a cavernous malformation appearing similar to prior and without significant associated edema or mass effect.5.No new intracranial masses to suggest metastatic disease.6.Scattered punctate susceptibility artifacts in the cerebellum and cerebral hemispheres which are nonspecific but may represent microhemorrhage, cavernomas, or microcalcifications appearing similar to prior.7.Chronic blowout fracture left lamina papyracea.