18 years Female (DOB:7/28/1997)Reason: ? vasculitis History: confusion and h/o lupusPROVIDER/ATTENDING NAME: JAMES AHN RIMAS V LUKAS MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a well-circumscribed focus of signal loss present in the left lentiform nuclei within the putamen which is associated with some enhancement.There is a tuft of enhancing serpiginous structures posteriorly with signal loss on susceptibility imaging located in the left frontal lobe adjacent to the left middle frontal gyrus which is suspected to represent a developmental venous anomalyThere is a mild degree of subcortical and periventricular punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are predominantly identified in the left hemisphere.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is relatively small to medium sized.. The right posterior communicating artery is medium-sized whereas the left posterior communicating artery is small to medium sized. The left vertebral artery is larger than the right vertebral artery. Findings also suggest a double origin left posterior inferior cerebellar artery. The vertebral arteries are similar in size.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is an ill-defined lesion present in the left basal ganglia. One possibility is that this may represent capillary telangiectasia.4.There is a lesion in the left frontal lobe which is suspected represent a developmental venous anomaly, however, it may be associated with capillary telangiectasia.5.There is a mild degree of subcortical and periventricular white matter lesions present predominantly in the left hemisphere. These are unusual at this age. Differential considerations include vasculitis as well as trauma, demyelinating disorder and vascular related lesions.6.Double origin left posterior inferior cerebellar artery.