 There is minimal residual decreased diffusion restriction within the right parietal and insular cortex with some associated right parietal cortical enhancement likely representing subacute infarction. There are numerous foci of supratentorial and infratentorial T2 hyperintensity as well as multiple foci of cerebellar and brainstem encephalomalacia compatible with chronic infarcts and small vessel ischemic disease. There are a few unchanged foci of susceptibility effect within the bilateral occipital lobes compatible with chronic microhemorrhages.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The distal vertebral and proximal basilar flow voids are again diminutive. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. There are bilateral lens implants. There is a small retention cyst within the right maxillary sinus.
1.Subacute right insular and parietal cortical infarcts. 2.Extensive chronic small vessel ischemic disease and numerous chronic brainstem and cerebellar infarct.3.Unchanged foci of chronic micro-hemorrhages in the bilateral occipital lobes.4.Unchanged near complete occlusion of the distal vertebral and proximal basal arteries.5.No MRI evidence of neuro-sarcoidosis. 