Magnetic susceptibility centred on the lateral aspect of the right Sylvian fissure, attributed to the previous coiling, limits assessment of this region.
There are multiple FLAIR hyperintensities throughout the periventricular and subcortical white matter. The GRE sequence shows about six punctate foci of susceptibility, likely to represent previous micro-haemorrhages. Grey-white matter differentiation is preserved. No diffusion restriction is appreciated.
Otherwise age-appropriate cerebral volume loss appears a little more pronounced in the left temporal lober. No corresponding perfusion abnormality is appreciated.
The MRA shows a small right-sided ACommA infundibulum.aneurysm. A foetal left PCA is noted.
CONCLUSION: The combination of findings is best explained by amyloid angiopathy with associated advanced chronic small vessel ischaemic changes. Small right-sided ACommA infundibulum/aneurysm warrants follow-up annually.