 MRI Brain:Again seen are postsurgical changes related to bilateral pial synangiosis. No evidence of intracranial hemorrhage, mass, or acute infarct. Scattered hyperintense FLAIR signal abnormality particularly involving the the bilateral centrum semiovale are redemonstrated and unchanged since prior exam. No new signal abnormality. Diffuse volume loss involving the left hippocampus is noted, particularly anteriorly. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. MRA Brain: Bilateral superficial temporal-distal MCA bypass appear grossly patent with susceptibility artifact slightly limiting evaluation. Redemonstrated is nonvisualization of the left M1 segment and proximal M2 segment. The distal left M2 segment is reconstituted through collaterals although the distal left MCA branches are diminutive compared to the right side. The right distal ICA and proximal right M1 segment show moderate luminal stenosis which is similar to the prior exam. There is redemonstration of bilateral ACA A1 segment luminal stenosis which is unchanged. The vertebral arteries, basilar artery, and posterior cerebral arteries also patent with no significant stenosis. No evidence of aneurysms or vascular malformations.MRA Neck: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries and cervical internal carotid arteries are normal in course and caliber. Both vertebral artery origins are patent. There is no evidence of stenosis or occlusion.
1.No evidence of acute infarct. Unchanged scattered foci of T2 signal abnormality likely reflecting small chronic infarcts particularly in the bilateral centrum semiovale.2.No new or worsening stenosis on MRA head compared to 4/5/2016. Please see details above.3.Unremarkable neck MRA and posterior intracranial circulation. 4.Significant volume loss involving the left hippocampus most consistent with mesial temporal sclerosis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.