36 years, Male, Reason: Please assess for brain AVMs, has HHT, hx of stroke related to large pulmonary AVMs. MRI BRAIN: There are at least five punctate foci of susceptibility effect which are seen on the susceptibility weighted sequence in the bilateral frontal lobes as well as the left thalamus. There may be an additional punctate focus in the left temporal lobe adjacent to the left temporal horn. No significant associated edema, gliosis, or enhancement. No restricted diffusion to suggest acute ischemia. No clear evidence of prior infarct. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Sella and orbits are grossly within normal limits. There is a right maxillary sinus mucus retention cyst and minimal bilateral maxillary sinus mucosal thickening. Bone marrow signal and extracranial soft tissues are grossly unremarkable.MRA HEAD: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. There is mild ectasia at the left A1-A2 junction without discrete aneurysm.
1. Multiple (at least 5) punctate foci of susceptibility effect involving the bilateral frontal lobes as well as the left thalamus are compatible with chronic microhemorrhages or possibly tiny cavernous malformations. 2. Mild ectasia at the left A1 A2 junction without discrete aneurysm. No findings to suggest arteriovenous malformation.