53 years Female (DOB:12/15/1962)Reason: s/p SRS intervention for dural AVM repair-12/12/14 History: SurveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD 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 mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 left jugular vein is smaller than the right jugular vein and substantially smaller when compared to pretreatment exams.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate a small opacity in the left mastoid air cells. The visualized portions of the orbits are intact.MRA brain:Compared to the previous exam the left external carotid artery vasculature remains stable compared to the prior exam but has decreased in caliber compared to immediate post treatment exams. The left mastoid artery can be identified extending into the left sigmoid sinus. The left ascending pharyngeal artery jugular branch is also identified extending to the jugular bulb.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 right posterior communicating artery is medium-sized. The left posterior communicating artery is tiny. The anterior communicating artery is small. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery.
1.Findings suggest a small residual arteriovenous fistula involving the jugular branch of the ascending pharyngeal artery. This has not changed substantially since the prior exam.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific.