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MRI Brain Senescent

MRI BRAIN WITHOUT IV CONTRAST: Sagittal T1, axial T2, axial FLAIR, and axial diffusion weighted images.

FINDINGS: Small old right MCA infarcts are present by evidence of encephalomalacia in the right frontoparietal cortex and linear susceptibility artifact in the right internal capsule (from old degraded blood products) causing mild ex vacuo dilatation of the right lateral ventricle.
Mild increased T2 and FLAIR signal is present in the right thalamus and right pons, which is diminutive compared to the left.
Atrophy of the right caudate is also noted.
Bilateral periventricular and subcortical T2 and FLAIR hyperintensities are present consistent with microvascular ischemic changes.
Otherwise, the configuration of the brain parenchyma and CSF-containing spaces are within normal limits for age.
There is no acute hemorrhage or space-occupying lesion.
Calvarial bone marrow signal is normal.

MRA HEAD WITHOUT CONTRAST: 3D TOF images of the brain without gadolinium. 3-D reformations of the brain MRA data were also performed.

FINDINGS: The distal internal carotid arteries are small in caliber at the carotid siphons laterally, giving rise to patent bilateral anterior and middle cerebral arteries. Small caliber arteries are present in right frontoparietal cortex. The distal vertebral arteries are nearly symmetric and terminate in a patent basilar artery and demonstrated posterior fossa branches. There is no aneurysm or evidence to suggest vascular malformation.

MRA OF THE CERVICAL CAROTID ARTERIES WITHOUT CONTRAST: 3D TOF images at the level of the carotid bifurcations with maximum intensity multiplanar reformations.

FINDINGS: There is mild narrowing of bilateral common internal carotid arteries just proximal to the bifurcations. The visualized portions of the vertebral arteries are without evidence to suggest flow-limiting disease.

1. There is no acute infarct. Evidence of multiple chronic right sided infarcts are present to include frontoparietal encephalomalacia, prior
internal capsule hemorrhage, caudate atrophy and increased T2 and FLAIR
signal in the right thalamus and pons. Additionally, there are
microvascular ischemic changes throughout the bilateral white matter.
2. Mild right greater than left narrowing of the carotid siphons, consistent
with atherosclerotic vascular disease evidenced by calcifications on the
prior CT.
3. Mild right greater than left common carotid narrowing just proximal to
the bifurcations consistent with atherosclerotic vascular disease.