75 years Female (DOB:4/16/1941)Reason: AVM brain, evaluate for changes, please do on the 3T scanner with CCM protocol for through evaluation. History: AVM brainPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There is a 17 x 20 mm axial dimension mass adjacent to the right frontal lobe abutting the postcentral gyrus just lateral to the hand motor area. It is associated with adjacent dural thickening. The meningioma is bright signal on FLAIR and T2. It enhances homogeneouslyThere is a second extra-axial mass abutting the right temporal lobe measuring 13 x 26 mm axial dimensions which is associated with the adjacent bony hypertrophy. This meningioma extends into the right transverse sinus. It is associated with a dural tail.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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:Time resolved MRA demonstrates early opacification of the right transverse sinus and sigmoid sinus with drainage into the jugular vein and condylar vein.There is a meningioma present adjacent to and involving the right transverse sinus which is supplied from right middle meningeal artery branches, right occipital artery , right ascending pharyngeal artery and posterior reticular artery branches. It drains primarily into the sigmoid sinus which subsequently drains out the jugular vein and condylar vein.The right frontal meningioma is associated with enlarged right middle meningeal artery branches.Antegrade 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 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.There are two small meningiomas identified. One of meningioma is located adjacent to the right temporal lobe and extends into the right transverse sinus. It has associated osseous thickening. There is no associated brain edema appreciated. It is supplied by external carotid artery branches and drains primarily into the sigmoid sinus with an arteriovenous fistula appearance. There is no convincing evidence for reversible venous flow based on this exam. It is not clear whether the transverse sinus is completely occluded. The second meningioma is adjacent to the right precentral gyrus and is not associated with early venous shunting.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. These are not unusual in number or distribution.3. No evidence for cerebrovascular occlusive disease.4.No evidence for intracranial aneurysm.