Episodic tension-type headache, intractable [G44.211], Reason for Study: ^Reason: r/o structural lesion History: HA associated with right side weakness Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There is no evidence of abnormal enhancement.Multiple small high signal intensities on subcortical white matter and periventricular white matter are non specific likely represent non specific small vessel ischemic disease.There are however multiple small susceptibility lesions at the right anterior temporal lobe and right posterior inferior temporal lobe without associated with surrounding edema. In particular, the left cerebellar hemisphere lesion is associated with developmental venous anomaly. A small susceptibility lesion just mesial to the DVA is likely to be adjacent venous structure instead of parenchymal lesion. Constellation of these findings suggest differential diagnosis of possibility of cavernous malformation, chronic petechial hemorrhages and calcifications. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Retention cyst on the left side of sphenoid sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate subtle luminal irregularities of intracranial arterial system without evidence of significant (more than 50%) luminal stenosis. Note is made that distal basilar artery shows about 20-30% luminal narrowing in conjunction with luminal irregularities of bilateral PCAs indicating atherosclerotic changes. No aneurysm is seen. Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery originates from the aortic arch directly. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement.2. 2-3 susceptibility lesions on the right temporal lobe with DVA on the left cerebellar hemisphere. Differential diagnosis include cavernous malformation, chronic petechial hemorrhage and calcifications.3. Atherosclerotic changes of intracranial arterial system without evidence of significant luminal narrowings. No aneurysm.4. Normal Neck MRA. 