Sickle cell disease. Evaluate for stenosis or moyamoya. Brain MRI:There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid in the right mastoid air cells and middle ear cavity which can be congestive or inflammatory. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Head MRA:The right internal carotid artery is slightly larger and more hyperintense compared to the left. The left A1 segment is small but there is a large right A1 segment along with a large anterior communicating artery providing preserved flow in the downstream right anterior cerebral artery and branches. The vertebral arteries codominantly supply the basilar artery. There is no left P1 segment but a large left posterior communicating artery provides the preserved flow in the more downstream left posterior-superior cerebral artery. There is no stenosis or aneurysm.
1.No evidence of acute intracranial hemorrhage, mass, or acute infarct.2.Fluid in the right mastoid cells can be congestive or inflammatory. 3.There is no vascular occlusion or moyamoya transformation. 4.Normal variations involving the anterior and posterior circulations are described above.