 There is no evidence of acute infarct. There is encephalomalacia predominantly involving the right parietal and temporal lobes, compatible with chronic infarcts. Foci of susceptibility in this area likely reflect chronic blood products, as well as T1 hyperintense laminar necrosis. There is additional area of volume loss and linear susceptibility involving the left external capsule, compatible with blood products associated with a chronic lacunar infarct. There are also chronic cerebellar infarcts, right greater than left, as well as small chronic infarct of the pons. There is volume loss of the right cerebral peduncle with abnormal signal extending to this level along the posterior limb of the right internal capsule, likely relating to ovarian degeneration.Additional mild scattered foci of periventricular and subcortical white matter FLAIR signal hyperintensity are nonspecific and compatible with chronic microvascular ischemic changes. There is minimal ex vacuo dilatation of the right lateral ventricle. Otherwise, the ventricles and basal cisterns are normal in size and configuration. The midline structures and craniocervical junction are otherwise within normal limits. There is no midline shift or herniation. No abnormal extra-axial fluid collection is identified.MRA HEAD
1.MRI brain showing multiple supratentorial and infratentorial chronic infarcts, without evidence of acute infarct are other acute abnormality.2.MR angiography of the brain showing irregularity and narrowing of the right MCA from the M1-M2 junction distally. No flow related enhancement of the right V4 segment.3.MR angiography of the neck showing likely chronic occlusion of the right vertebral artery with reconstitution of the distal V2 to mid-distal V3 segments by segmental collaterals. Dominant left vertebral artery with likely developmentally diminutive basilar artery.