Mri found bilaterally along the inferior lateral aspect of the basal ganglion, either old lacunar infarctions or bilateral benign cysts. Thoughts?

Either unusual. The chance of lacunar infarcts in a 23 yo is pretty low. Similarly, having "bilateral cysts" seems somewhat unlikely, nor am i sure what kind of "cysts" the radiologist would be referring to. Review your MRI with your doctor.