Diagnosis: Hereditary hemorrhagic telangiectasia. Disorder of brain, unspecified. Other malformations of cerebral vesselsClinical question: 3T Scanner; please evaluate dural based lesion and likely AVM seen on May MRI/MRA for changes, growthSigns and Symptoms: Close surveillance of known lesions. HHT. MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of serpiginous flow voids extending in a linear fashion from the central sulcus just lateral to the hand motor area through along the perimedullary veins to the right lateral ventricle. There is associated enlargement of relevant cortical veins and subependymal veins.There is redemonstration of an extra-axial left parafalcine enhancing mass measuring 25x23 mm on coronal imaging and 28x25mm on axial imaging. There is associated susceptibility effect within the lesion. There is no evidence for signal change in the adjacent brain parenchyma. The adjacent superior sagittal sinus is narrowed and possibly occluded.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. The left A1 segment is larger than the right A1 segment. The ACOMA is small. There is fetal origin of the left PCA with a large left p1 segment almost as large as the PCOMA. The right PCOMA is small.There is enlargement of the right posterior parietal artery, the right precentral artery and the central arteries associated with cortical and subependymal venous opacification.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.Findings are compatible with a small AVM involving the right central sulcus with both superficial and deep venous drainage. The cortical venous drainage appears to drain anterior to the meningioma. The patient will need to be recalled to include the entire brain on the MRA at no expense to the patient.2.A left parafalcine meningioma is stable in size. It appears to narrow or obstruct the superior sagittal sinus. An MRV would help distinguish between narrowing and occlusion of the superior sagittal sinus if this is clinically relevant. 3.There is not evidence for cerebral edema.