 MRI brain:Punctate focus of diffusion restriction along the posterior limb of the left internal capsule. No other areas of diffusion restriction are identified. There are chronic lacunar infarcts noted in the pons and left thalamus. Pontine infarct also is associated susceptibility artifact suggesting chronic microhemorrhage. Volume loss in the cerebellum is noted. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.The midline structures and craniocervical junction are within normal limits. MRA brain:MRA is slightly limited by artifact. Mild irregularity involving the right cavernous and supraclinoid ICA segments as well as minimal irregularity of the right M1 segment, without high grade stenosis. The nondominant distal left vertebral artery is diminutive, especially beyond the PICA origin. There also appears to be a focal high-grade stenosis at the left vertebrobasilar junction. While these findings are probably related atherosclerosis, the possibility of remote dissection cannot be excluded. No findings to suggest intimal flap. 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 normal in course and caliber, without evidence of stenosis or occlusion.Both vertebral artery origins are patent. The right vertebral artery is dominant. There is no evidence of stenosis or occlusion in the extracranial portions of the major neck vasculature.
1.Punctate focus of acute infarct along the posterior limb of the left internal capsule. Chronic left thalamic and pontine lacunar infarcts.2.Diminutive nondominant distal left vertebral artery, particularly beyond the PICA origin, with more focal high-grade stenosis at the left vertebrobasilar junction. Findings may related to atherosclerotic disease although possibility of prior dissection is not entirely excluded. 3.Other low-grade stenoses/irregularities in the right ICA and MCA, as described above.4.No significant steno-occlusive lesion in the arterial vasculature in the neck.