New onset HA, visual disturbance. Brain MRI: A small focus of enhancement is noted just inferior to the right caudate head which also demonstrates susceptibility abnormality. There is no surrounding hypointensity on T2/FLAIR to suggest edema. There is also no evidence of restricted diffusion. Constellation of above findings suggest possibility of cavernous malformation. Differential diagnosis include cavernous malformation with associated capillary telangiectasia. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull and scalp soft tissues are grossly unremarkable.Orbits MRI:No abnormal mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.Brain MRA:The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations.Neck MRA:There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber, without evidence of stenosis or occlusion. There is a left dominant vertebral artery. The C6 level of the right vertebral artery shows crossing of venous structure and overlapped deep cervical artery which created an artifactual narrowing of that segment on MIP reformat image. There is no evidence of stenosis or occlusion.
1.Small enhancing lesion just inferior to the right caudate head with associated susceptibility abnormality but without restricted diffusion. Differential considerations include cavernous malformation or cavernous malformation associated with capillary telangiectasia. Additional less likely considerations are subacute lacunar infarct or hemorrhage as well as metastasis. Mild mucosal thickening is noted of the left sphenoid sinus which is nonspecific. 2.No significant sterile occlusive disease or aneurysm involving the intracranial and extracranial craniofacial vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.