evaluate for avm. HIV, history of CNS toxoplasmosis. MRI of the brainHeterogeneous signal present along the medial right parietal lobe with a gyriform T1 signal hyperintensity and T1 hypointensity as well as a 10 x 15mm irregular ring enhancing lesion with eccentrically thickened wall. This ring enhancing component is adjacent to the trigone of the right lateral ventricle. On the T2 imaging there is a surrounding white matter signal change in the mild asymmetry in the size of the trigone of the right lateral ventricle with right larger than left.A small focus of encephalomalacia is present at the right centrum semiovale.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries. Right vertebral artery is hypoplastic distally and predominantly supplies the right posterior inferior cerebellar artery. The right posterior cerebral artery slightly larger than the left posterior cerebral artery. There is a narrowing of the right posterior cerebral artery as it courses through the right medial occipital lobe lesion.There is fenestration of the right internal carotid artery at the ophthalmic segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is somewhat irregular in appearance which may be a result of its course. The left A1 segment is larger than the right A1 segment. The posterior communicating arteries are readily identified
1.There is a right occipital lobe lesion which is ring enhancing. Given the patient's clinical history, it is suspected this may represent a reactivation of prior infection such as toxoplasmosis with some dystrophic calcifications. Presence of associated acute hemorrhage is less uclear. A comparison with a prior exam may be helpful. This finding was discussed with Dr Ardelt at the time of this dictation. It is of course concerning at this is immediately adjacent to the right lateral ventricle.2.No evidence for AVM.3.No evidence for intracranial aneurysm. The intercommunicating artery appears somewhat irregular however.4.There is narrowing of the right posterior cerebral artery adjacent to the right occipital lobe lesion.5.Incidental load is made of fenestration of the right internal carotid artery at the ophthalmic segment