Diagnosis: Unspecified epilepsy without mention of intractable epilepsy. Congenital anomaly of cerebrovascular system. Other specified delay in development. Obstructive hydrocephalusClinical question: vein of galen malformation , embolized , seizures, yearly follow up for changes MRI of the brainNo diffusion weighted abnormalities are appreciated.There is redemonstration of ventriculomegaly. There is redemonstration of periventricular white matter lesions which are stable compared to the previous exam and associated with loss of the white matter mantle.The patient is status post embolic occlusion of a vein of Galen malformation. There are embolic coils present within the vein of Galen aneurysm.The third ventricle is shifted mildly towards the right side. There is partial opacification of the right mastoid air cells.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 superior sagittal sinus. The internal cerebral veins are identified. The straight sinus, however, is not readily identified.The visualized portions of the paranasal sinuses demonstrate mucous retention cysts in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.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.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The vertebral arteries are similar in size. The left A1 segment is larger than the right A1 segment. The posterior communicating arteries are medium-sized. The anterior communicating artery is medium-sized.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent but are not connected to the vein of Galen which is not present. . The straight sinus appears diminutive and possibly drains the inferior sagittal sinus. The basal veins drain into the perimesencephalic venous system. Drainage of the internal cerebral veins appears to be into the posterior fossa venous drainage system.
1.Examination is stable and compared to the prior exam. The patient status post embolic coil occlusion of vein of Galen aneurysm.2.There is alteration of the venous drainage system which appears stable.3.No new arteriovenous fistulas are appreciated.4.There is redemonstration of ventriculomegaly and periventricular leukomalacia.