psychosis, neuropsychiatric lupus. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.Developmental venous anomaly (normal variation of venous drainage) is seen on the right temporal lobe superior temporal gyrus crossing underneath of the right Heschel's gyrus toward right lateral ventricle posterior horn ependymal vein.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate decreased luminal diameter of bilateral distal intracranial ICAs (left worse than right). In addition, bilateral proximal MCA M1 and bilateral ACA A1 segments also show decreased luminal diameter. However, distal MCAs and distal ACAs appear to be normal. Angiographically, these findings constitute Moyamoya syndrome.Vertebrobasilar system appears to be normal.Right Pcom artery appears to be patent and normal size.The left PCA is fetal origin.There is no intracranial arterial aneurysm.3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate normal flow enhancement in the superior sagittal sinus, transverse sinuses, sigmoid sinuses, internal cerebral veins, vein of Galen and straight sinus.
1. No evidence of acute ischemic or hemorrhagic lesion.2. No evidence of abnormal enhancement.3. DVA on the right superior temporal gyrus.4. Normal brain MRV.4. Bilateral distal intracranial ICA and proximal MCAs and ACAs luminal narrowing on MRA. This may represent Moyamoya syndrome. Clinical correlation is recommended.Discussed with Dr. Di-Ranieri at the time of this dictation. 