Evaluate STA to MCA bypass. MRI Brain: There is no restricted diffusion to suggest acute ischemia. There is extensive bihemispheric cerebral white matter T2 hyperintensity, left much greater than right, slightly progressed in the left anterior frontal and right anterior temporal lobes compared to 11/15/2015. There are otherwise multiple unchanged chronic lacunar infarcts involving the deep grey nuclei and surrounding white matter. The ventricles and sulci are diffusely prominent compatible with cerebral volume loss. There has been interval resolution of swelling and fluid in the scalp soft tissues overlying the bypass site. MRA Brain: There is a left-sided STA-MCA bypass, which is partially obscured by metal susceptibility effect. The portions not affected by the artifact otherwise appear to be intact. There is persistent paucity of flow-related enhancement of the majority the left internal carotid artery, with reconstitution at the distal supraclinoid portion. There is slightly decreased flow related signal in the left middle cerebral artery compared to the right, but no significant stenosis is apparent. There is irregularity of the cavernous and supraclinoid right internal carotid artery. There is an unchanged 2 mm outpouching of the right anterior communicating artery. There is also an unchanged 5 mm aneurysm along the right lateral cavernous internal carotid artery. There are unchanged multifocal stenosis affecting the distal vertebral, basilar artery, and posterior cerebral arteries.
1.Postoperative findings related to left STA to MCA bypass, which is incompletely characterized due to susceptibility artifact from adjacent surgical hardware. 2.Right supraclinoid internal carotid artery and anterior communicating artery aneurysms are unchanged.3. Progression of white matter chronic ischemic disease, but no acute infarction.4. Unchanged multiple chronic lacunar infarctions in the bilateral deep grey nuclei.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.