Restricted diffusion affecting the right hemipons, medial right cerebellar hemisphere in the right PICA vascular territory. Further patchy areas of diffusion restriction throughout the remainder of the cerebellar hemispheres and vermis as well as both occipital lobes, mesial temporal lobes, right thalamus, and the splenium of the corpus callosum. These areas have corresponding T1 hypointensity, T2 hyperintensity and positive mass effect. Partial effacement of the fourth ventricle. No hydrocephalus. No cerebral parenchymal herniation.
TOF MRA demonstrates absent flow signal in the right vertebral artery with irregularity and T1/T2 hyperintensity in the proximal basilar artery but normal flow in the remainder of the basilar artery. Scanty flow signal in the right PICA compared to the left.
No abnormal susceptibility artifact with no evidence of intracranial haemorrhage or DAI. Supratentorial deep white matter T2 and regions of hyperintensity are non-specific, but most likely represent the sequelae of chronic small vessel ischaemic change, but are of an amount more than expected for this group.
Large scalp fluid intensity subgaleal collection with only minor susceptibility artifact. More anteriorly is a small left frontal scalp haematoma with a fluid-fluid level present.