 Brain MRI:The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. The paranasal sinuses and mastoid air cells are clear. Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions, arteriovenous reformations, or aneurysms are identified. Incidental note is made of a tiny fenestration involving the proximal basilar artery. The right superior cerebellar artery appears diminutive and irregular with time-of-flight technique, however it normally fills with contrast and has a normal appearance on subsequent contrast enhanced neck MRA.Neck MRA:There is conventional takeoff of the great vessels from the aortic arch without evidence for stenosis of the origin of the great vessels or of the bilateral vertebral arteries which are codominant. There are no stenoses of the bilateral common, internal or external carotid arteries or of the bilateral carotid bifurcations. There is no evidence for vasculitis, fibromuscular dysplasia or dissection of the carotid or vertebral arterial systems within the neck. There are no vascular masses identified. There is irregularity of the right subclavian artery distal to the right vertebral artery origin.
1.Negative MRI of the brain including gadolinium enhancement.2.Negative MRA of the brain.3.There is irregularity of the right subclavian artery distal to the right vertebral artery origin. Dedicated subclavian artery CT angiography is recommended to better characterize this finding, in this location, as well as to assess the adjacent soft tissues for possible impingement.