43 years Female (DOB:7/23/1973)Reason: CCM Protocol, 3T Scanner History: known CCM diseasePROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRA brain: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.The origin of the right frontal polar artery gives the appearance of the anterior communicating artery fenestration.. There is an infundibulum present along the left A2 segment. There is a 1 mm aneurysm versus infundibulum along the left A2 segment more distally.MRI brain:There is a 6 mm lesion present within the lower midbrain which has peripheral susceptibility effect and a popcorn-like appearance associated with a large draining vein within the pons. There are associated punctate foci of signal loss at the adjacent pons and lower midbrain not readily appreciated on the other sequences. When compared to the previous exam there is not a significant interval change.Small lesion present within the right superior frontal gyrus subcortical white matter is associated with susceptibility effect and some punctate T1 signal hyperintensity and measures approximately 4 mm in size. Another similar-appearing lesion is present within the left occipital lobe along the lingual gyrus subcortical white matter. When compared to the previous exam there is not a significant interval change.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.
1.Findings are compatible with a small cerebral cavernous malformation centered within the lower midbrain which is stable compared to prior exam. It is associated with a developmental venous anomaly. Punctate lesions in the surrounding tissue could represent small cavernomas or microhemorrhages. This is stable compared previous exam.2.Lesions also present in the right frontal lobe and in the left occipital lobe are also compatible with a small cavernomas. These are also stable when compared to the previous exam.3.1 mm infundibulum versus aneurysm along the left A2 segment.