Findings:
No intra- or extra-axial mass lesion or collection is identified. The ventricles and sulcal spaces are within normal limits. The midline structures are normal with no midline shift.
Smaller, postischaemic areas of encephalomalacia with surrounding gliosis are noted in the cortical watershed zones involving the frontal white matter bilaterally, more prominent on the right.
No abnormal signal on the susceptibility-weighted images or diffusion/ADC images is identified.
On the arterial TOF bilateral EDAS (Extracranial-Intracranial Arterial Bypass) is seen with encephaloduroarteriosynangiosis with pial synangiosis over anastomosis from the superficial temporal arteries, with larger collateral vessels in the middle cerebral artery territories, more significant on the right. The peripheral ACM branches are patent.
Nearly absent flow signal within the proximal part of the left cavernous ICA as well as the supraclinoid portion of the ICAs and the M1 segments bilaterally. The M2 branches on the left demonstrate moderate narrowing.
Also, significant narrowing of the A1 and proximal A2 segments is seen bilaterally.
Normal calibre of the vertebral and basilar arteries, as well as the posterior cerebral arteries.
The pituitary gland is mildly prominent and rounded.
Previous bilateral frontal and right temporal cranioplasty.
The orbits, paranasal sinuses and mastoid air cells are clear.
Conclusion:
No acute ischaemic event.
EDAS (Extracranial-Intracranial Arterial Bypass) bilaterally with larger collateral vessels in the middle cerebral artery territories (right>left) and normal flow within the peripheral MCA branches bilaterally.