Congenital anomaly of cerebrovascular system [747.81] / Hereditary hemorrhagic telangiectasia [448.0], Reason for Study: ^Reason: AVM, prior hemorrhage in 2014, please evaluate, HHT History: HHT, motor, cognitive, speech deficits from previous stroke Brain MRI:There is extensive left parieto-occipital encephalomalacia.There is evidence of left fronto-temporo-parietal craniotomy.Within the encephalomalacia, there are multiple somewhat punctate and tubular restricted diffusion lesions indicating acute ischemic infarctions at remained brain parenchyme.There are enlarged left PCA and its branches converging into the left posterior aspect of the temporal lobe middle temporal gyrus area nidus. The size of the nidus was measured about 23mm(R to L) x 18mm (AP) x 17mm (Craniocaudal). There is large draining vein on the posterior temporo-occipital cortex and reaching into the left transverse sinus.The left lateral ventricle shows ex vacuo changes.There is no evidence of acute hemorrhagic lesion.Multiple susceptibility lesions on the left frontal, parietal and temporal lobes may be related to prior hemorrhagic stroke.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate enlarged left ICA with fetal left PCA which is also enlarged.There is no identifiable arterial aneurysm.Right ICA, bilateral ACA, bilateral MCA and vertebrobasilar system appear to be normal.
1. Acute ischemic infarctions without hemorrhagic transformation on the left hemisphere especially on the remained brain parenchyme within encephalomalacia as described above. 2. Left temporooccipital brain AVM mainly supplied by the left PCA.3. Left hemispheric extensive encephalomalacia.