Moyamoya with history of transient ischemic attack, aneurysm and subarachnoid hemorrhage. Please assess for degree of stenosis and for aneurysms. Brain MRI:There is no evidence of acute infarct or discrete area of encephalomalacia to suggest prior infarct. No appreciable evidence of intracranial hemorrhage. The ventricles and other CSF-containing spaces are normal in size. No intracranial mass or mass effect. There is no midline shift or brain herniation. A partially empty sella is noted and a may be normal variant in this age group. The orbits are grossly unremarkable. Mastoid air cells are clear. There is trace mucosal thickening in the ethmoid sinuses.Cranial MRA:The included cervical right internal carotid artery is small, especially in its supraclinoid segment which has not significant changed since the previous examination. The right M1 segment is occluded proximally, but flow reconstitutes in its distal part and along its more distal branches through enlarged right lenticulostriate arteries; distal MCA branches however remain asymmetrically attenuated compared to the contralateral side. The right A1 segment is not clearly visualized and may at least in part be related to hypoplasia. Flow in the A2 segments and distally is preserved and symmetric. Overall appearance has not significantly changed since the previous examination. In addition, the fusiform dilatation of the anterior communicating artery is also unchanged nor the two small (2-3 mm each) wide-neck aneurysms; one pointing inferior-left laterally and another superior and right laterally. There is also an unchanged small aneurysm arising from the cavernous left internal carotid artery measures 4 mm at its base and 2 mm in height. The vertebrobasilar circulation is preserved. Large right posterior communicating artery, which is a normal variation.
1.Right-sided moyamoya pattern has not significantly changed since previous CT angiogram from November 2015 with nonvisualization of the distal right ICA and proximal right M1 segment with flow partially reconstituting through prominent lenticulostriate arteries. 2.Flow in the distal right middle cerebral artery branches is attenuated. There is no evidence of infarct or hemorrhage.3.Small aneurysms along the dilated anterior communicating artery as well as the small aneurysm of the cavernous segment of the left internal carotid artery remain unchanged. 