59 years Female (DOB:10/19/1956)Reason: 3T scanner, please evaluate for Moyamoya disease, hx of TIA, recent syncopal episode, last imaging in 2014, please compare History: 3T scanner, please evaluate for Moyamoya disease, hx of TIA, recent syncopal episode, last imaging in 2014, please comparePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is diffuse marrow replacement present.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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 demonstrate mucosal thickening in the maxillary sinuses right more than left. There is mild mucosal thickening in the right anterior ethmoid air cells. 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 mild narrowing at the origin of the left middle cerebral artery. There is mild to moderate narrowing of the proximal portion of the inferior division of the left middle cerebral artery with approximately 50% narrowing. This is stable compared to the prior exam. The inferior division of the left middle cerebral artery is the dominant division.There is approximately 25% narrowing at the proximal right middle cerebral artery present. This is stable compared to the prior exam.There is mild narrowing at the left P2 segment of the posterior cerebral artery by approximately 30%. This is stable compared to the prior exam.There is no evidence for intracranial aneurysm.The anterior communicating artery is identified. The posterior communicating arteries are intact. The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery present.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the right vertebral artery. There is 50% narrowing at the origin of the left vertebral artery. This is stable compared to the prior exam.
1.Two foci of narrowing are present along the left M1 segment. One at its origin is 30% narrowed and one at the proximal portion of the inferior division is 50% narrowed by WASID criteria. This is stable compared to the prior exam.2.There is mild narrowing of the proximal right middle cerebral artery present but also the left P2 segment of the PCA. This is stable compared to the prior exam.3.There is 50% narrowing at the origin of the left vertebral artery. This is stable compared to the prior exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. They are most likely vascular related. 