Clinical question: Sudden onset of right hand weakness following tordol/reglan/benadryl in HgSS/Moyamoya. Signs and symptoms: Right hand weakness, minimal right leg weakness. Pre-and post-enhanced brain MRI:No evidence of acute ischemic findings on diffusion weighted series.There is diffuse left hemispheric white matter flair and T2 hyperintensity signal which demonstrate no convincing evidence of any significant interval change since prior exam. Asymmetrical left-sided prominence of cerebral cortical sulci also remains identical to prior study. The left lateral ventricle is also mildly prominent likely representing ex vacuo dilatation which is also stable since prior exam. Findings are suspicious of chronic ischemic changes in the deep left hemispheric white matter.Very minimal similar findings in the right centrum semiovale also remains nearly identical to prior exam.The overall anatomical morphology and the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences. Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement. Calvarium demonstrate postoperative changes. There is revisualization of very small caliber of left internal carotid artery across the skull base and in its supraclinoid segment similar to prior exam. Postop changes of calvarium likely for arterial anastomotic surgery. Correlate with past surgical history.
1.No evidence of an acute or new finding since prior exam.2.Stable extensive left hemispheric subcortical and periventricular chronic ischemic changes and minimal similar findings in the right hemisphere since prior exam.3.Revisualization of a very small caliber left internal carotid artery across the skull base and its supraclinoid segment.4.Post operative changes of the left calvarium likely are vascular anastomosis surgery.5.No detectable abnormal enhancement.