Hypodense gliosis in the right ACA territory in keeping with prior infarct. Similar post-ischaemic gliosis in the left temporal lobe. No new area of grey-white matter differentiation loss. No insular ribbon sign. No dense vessel sign evident on the thin data set. No haemorrhage, surface collection, mass effect or midline shift. Ex vacuo dilatation of the right lateral ventricle. Prominent CSF in the right CP angle with mild mass effect on the right cerebellar hemisphere is an arachnoid cyst which is stable.

No intracranial vascular occlusion identified. High-grade stenosis due to calcified and noncalcified plaque of the dominant right V4. The nondominant left vertebral artery terminates as a PICA. Heavily calcified right vertebral artery, bilateral cavernous ICAs and right terminal ICA. The right common carotid artery bifurcation demonstrates irregular calcified and noncalcified plaque which extends into the proximal ICA causing a high-grade ICA stenosis. Surgical clips anterior to the left carotid sheath. Dural venous sinuses enhance normally.

The old right ACA territory infarct demonstrates markedly decreased CBV and CBF as expected. Similar changes in the left temporal pole.

Decreased MTT, Tmax and TTD in the right cerebral hemisphere affect the ACA and MCA territories and spares the occipital lobe (PCA territory). No corresponding CBF or CBV abnormality on the right to suggest core infarct.