Bilateral subcortical and periventricular white matter T2 hyperintensity without evidence of restricted diffusion, in keeping with chronic small vessel ischaemic change. Further chronic ischaemic change within the brainstem. Chronic left frontal lobe cortical infarct.
High signal within the left cavernous sinus on MRA, similar to the adjacent internal carotid artery. High signal within the dilated left superior ophthalmic vein representing arterialised retrograde flow. This is in keeping with a left caroticocavernous fistula. Flow related artifact within the cavernous sinus with no evidence of cavernous sinus thrombosis.
Additionally, there are enlarged external carotid branches (occipital and posterior auricular) on the left feeding a left transverse sinus dural arteriovenous fistula.