Female, 71 years old, with left lateral gaze deviation. Brain MRI:A 3 mm focus of restricted diffusion is evident within the right dorsal paramedian pons just below the facial colliculus, in the region of the PPRF. No other restricted diffusion is seen.Multiple small chronic infarcts are seen involving the right pons and right ventral medulla, the bilateral thalami, and in the left cerebellar hemisphere. These lesions appear unchanged from the prior exam.No evidence of acute intracranial hemorrhage is seen. The ventricular system is normal in size and morphology.MRA brain:At least moderate narrowing of the laceral segment of the left ICA is seen. The right terminal ICA appears to be at least moderately narrowed as well. These findings are unchanged. The right A1 segment is hypoplastic. A normal-appearing ACOM artery is visualized. No high-grade vascular stenosis or occlusion is suspected within the MCA distributions. The vertebrobasilar system is free of significant vascular stenosis. A small PCOM artery is evident on the right, and there may be a very small PCOM artery on the left. No aneurysm or vascular malformation is detected.MRA neck:No high-grade stenosis is suspected within the carotid vessels of the neck by NASCET criteria. No high-grade stenosis is suspected within the vertebral vessels of the neck. Image quality is probably not adequate for the detection of very subtle areas of vascular narrowing.
1.Small, acute ischemic lesion in the right dorsal paramedian pons, just below the facial colliculus in the vicinity of the PPRF.2.Multiple scattered small chronic strokes, including within the pons and medulla, unchanged.3.Moderate chronic microvascular ischemic disease, unchanged.4.At least moderate narrowing is evident within the left ICA laceral segment and at the right terminal ICA, unchanged from prior. No definite high-grade stenosis is seen elsewhere intracranially.5.No significant vascular stenosis is detected in the vessels of the neck.