There is widespread long segment concentric vessel wall thickening and hyperenhancement throughout the brain, involving particularly the M2, M3 and M4 MCA branches bilaterally, bilateral PCAs and right medial lenticulostriate vessels. Known focal stenosis of the superior M2 division of the left MCA. Occluded M3 branch of left inferior M2 division with focal T1 hyperintensity in the left sylvian fissure. Occluded M3 branch of the right inferior M2 division. Known subacute infarct in the right basal ganglia.
Extensive bilateral hemisphere long segmental vessel wall thickening and hyperenhancement in keeping with vasculitis. Secondary and primary vasculitis both need to be considered.