Bilateral terminal ICA tapering occlusions, above the level of the relatively large calibre PCOM's, is again noted, along with mild-to-moderate residual lenticulostriate moyamoya phenomenon.
Bilateral STA to MCA bypasses appear patent, with MCA branches maintaining good flow signal beyond the Sylvian fissures. Accordingly, contrast-enhanced PWI shows relatively preserved cerebral blood flow and volume on both sides, with no major perfusion defect shown.
In addition, no overt infarct/ischaemic change, diffusion restriction or magnetic susceptibility is shown, apart from a solitary 4 mm chronic ischaemic focus in the posterior right frontal centrum semiovale.
In addition, no overt residual/recurrent intra/extra-axial haematoma is shown.
A small inferior basilar artery fenestration is evident, with no posterior circulation stenosis demonstrated.
The remainder of the study is unremarkable.