Findings:
Small foci of diffusion restriction are noted in the territory of the right PICA in the right cerebellar hemisphere as well as in the right PCA territory, involving the right-sided midbrain and extending superiorly to the right thalamus. The lesions show increased signal intensity on T2/FLAIR sequences with homogeneous enhancement on the postcontrast study. No significant perifocal oedema, no haemorrhagic changes.
Partially confluent zones of T2/Flair hyperintensity involving the subcortical and periventricular cerebral white matter are noted, in keeping with small vessel ischemic disease.
Mild involutional changes are seen in the brain parenchyma in the form of prominent cortical sulci and widened ventricles. There is no midline shift.
The pituitary gland is normal.
Bilateral IOL implants are noted. The paranasal sinuses and mastoid air cells are clear.
No bony abnormality is seen. The craniocervical junction is normal.
Conclusion:
Foci of diffusion restriction with contrast enhancement in the right cerebellar hemisphere (PICA territory) as well as in the right midbrain and thalamus (PCA territory), likely in keeping with subacute infarcts. Further surveillance to rule out sinister pathology is advised.