Result for my brain mri -asymmetric decreased attenuation in the left basal ganglia, variant dilated perivascular spaces or punctate chronic lacune. ?

MRI report: This is language used in radiology to describe what they see. Ordinarily, they cannot distinguish a small stroke (lacune) from a perivascular space. A "puntate lacune" though is very small. It is probably just the side view of a blood vessel (aka perivascular). Do you smoke? Do you have high blood pressure? Do you have diabetes mellitus? Atrial fibrillation? These are stroke risk factors.

A little confusing,: because "attenuation" is an X-ray/CT term relating to how much of the X-ray is absorbed by the tissue or structure. It has no meaning in MRI, which uses magnetic fields and not X-rays. A punctuate lacune would be a tiny old infarct. A dilated peri vascular space is usually an incidental finding. They can look similar.