Hereditary hemorrhagic telangiectasia, evaluate for brain AVM There is no evidence of acute ischemic or hemorrhagic lesion.Bilateral basal ganglia especially globus pallidus shows high signal intensity on T1-weighted imaging but reasonably normal signal intensity on T2 and FLAIR imaging indicate differential diagnosis of chronic liver disease, non ketotic hyperglycemia, chronic exposure to Manganese and long term treatment with total parenteral nutrition.There is no definitive evidence of abnormal enhancement.On FLAIR images, there are scattered punctate high signal intensity lesions on bilateral periventricular white matter indicate non specific small vessel disease.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. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal.However, the source image shows vascular enhancement of the anterior aspect of the Superior Sagittal Sinus as well as a cortical vein on the right frontal lobe (series #401, image . There is also slightly increased vascularity on the superior posterior aspect of the vermis (series #401, image 103/192). Since this is a TOF MRA, unless there is technical errors, visualization of venous structure may indicate arteriovenous shunting. Therefore, diagnostic catheter angiography may be considered for further imaging investigations.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Bilateral globus pallidi high signal intensities on T1 weighted image indicate possibilities of chronic liver disease,non ketotic hyperglycemia, chronic exposure to Manganese and long term treatment with total parenteral nutrition as discussed above.3. Visualization of cortical vein of the right frontal lobe and anterior aspect of the superior sagittal sinus may indicate possible arteriovenous shunting. Catheter angiography can be considered for further evaluation. 