Moyamoya disease [I67.5] / Neurofibromatosis, unspecified [Q85.00], Reason for Study: ^Reason: is there any evidence of ischemia History: girl with NF1 and moyamoya and renal artery stenosis Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion.Previously recognized multifocal small, somewhat nodular and somewhat patchy high signal intensity lesions on FLAIR/T2 at bilateral internal capsules, thalami, cerebral peduncle, left inferomesial cerebellar hemisphere and right internal capsule genu appear to be stable since prior scan. There is no new abnormal signal intensity lesion seen on today's scan.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. Small left parietal scalp nodule, no change in size and MR characteristics since prior scan.The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.No change of right maxillary sinus retention cyst.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the distal ICA beyond the level of the right ophthalmic artery origin. The right MCA appears to be reconstituted via collateral vessels but the luminal diameter of the reconstituted right MCA is very small, unchanged since prior scan. The left ICA, MCA and bilateral ACAs appear to be normal without showing any evidence of luminal irregularity.Vertebrobasilar system shows hypoplastic left distal vertebral artery, otherwise unremarkable.There is no evidence of intracranial arterial aneurysm.Bilateral Pcom arteries and Acom artery are patent.
1. Re-demonstration of multifocal parenchymal high signal intensity lesions on FLAIR/T2 images, no change since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion. No new abnormal signal intensity.3. Complete occlusion of the distal right ICA with reconstitution of the right MCA via collateral vessels, no change since prior scan. Unremarkable left ICA, bilateral ACAs, left MCA and vertebrobasilar system. 