 Images are slightly limited by patient motion. The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes. In addition, there is a chronic right paramedian occipital lobe infarct with focal encephalomalacia. There is no diffusion abnormality. No extra-axial fluid collection is identified.The intracranial right vertebral artery flow void is not visualized. Normal flow-voids are demonstrated in the remainder of the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is redemonstration of a prominent deep left-sided scalp hematoma measuring 20 mm in greatest thickness. Patient's known C1 and C2 fractures are not well visualized on this portion of the exam.MRA HEAD
1. Severely motion limited exam.2. No evidence of acute infarct. Mild-moderate chronic small vessel ischemic changes of chronic right occipital lobe infarct.3. Redemonstration of nonvisualization of the entire imaged cervical and intracranial right vertebral artery consistent with previously suspected occlusion which again may relate to traumatic dissection versus direct compression occlusion from surrounding traumatic injury. Please note that specific dissection sequences were inadvertently not performed.4. Right posterior cerebral artery distal to the P1-P2 junction appears diminutive in caliber as compared to prior CTA.5. Suboptimal evaluation of known C1 and C2 fractures. Redemonstration of prominent prevertebral soft tissue edema.