18 years Female (DOB:6/14/1998)Reason: 3 t scanner hht History: surveillancePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainThere is redemonstration of patchy T2 signal hyperintensity along the anteromedial aspect of the medulla bilaterally as well as along the anterior aspect of the pons.There is redemonstration of a small T2 and FLAIR hyperintense focus along the superior aspect of the cingulate gyrus adjacent to the bend of the marginal ramus of the cingulate sulcus which is unchanged since prior exam.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Along the left cingulate sulcus there is a dilated artery present which connects to a draining vein which involves the adjacent cingulate gyrusAntegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is some vague vascular structures present along the medial aspects of the medulla and pons on the postcontrast MRA.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.Findings are suspicious for a small arteriovenous malformation located along the left cingulate gyrus just adjacent to the cingulate sulcus and marginal ramus which is unchanged compared to prior exam.2.There are small lesions present in the medulla and pons which are stable compared to the prior exam. These are nonspecific. There is no direct evidence for arteriovenous malformation on the MRA. There are some small vascular structures that can be discharged within these are Given the patient's known clinical history of HHT, however, underlying vascular lesions such as so-called capillary telangiectasia is suspected.