 MRI head: There is no diffusion abnormality to indicate acute infarction. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter as well as in the pons, consistent with extensive chronic small vessel ischemic changes, and minimally progressed from prior. Scattered supratentorial lacunar infarcts also seen such as in the right temporal white matter, thalami and right caudate head. There are also small lacunar infarcts in the bilateral cerebellar hemispheres.Again seen is a lipoma measuring about 13 x 11 mm abutting the pontomedullary junction without significant mass effect and unchanged. There is susceptibility associated with the lipoma compatible with mineralization.The ventricles and sulci are mildly prominent and unchanged from the previous exam. There is no midline shift or mass effect. The basal cisterns remain patent. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is diffuse opacification of the right sphenoid sinus better seen on prior CT as well as trace mucosal thickening elsewhere.MRA head: The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. There are patent bilateral posterior communicating arteries, larger on the left. The right vertebral artery is dominant. Basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.
1. No evidence of acute ischemia.2. Extensive chronic small vessel ischemic disease, minimally progressed since 4/19/2013.3. Unchanged lipoma at the pontomedullary junction without mass effect, not significantly changed.4. No evidence of high-grade stenosis or occlusion in the anterior or posterior intracranial circulation.