Moyamoya, migraines. Any strokes or clots or other vascular abnormalities. Few tiny nonspecific foci of T2/FLAIR hyperintensity in the bilateral frontal white matter, greater on the right, are again seen. No new lesion is identified. No intracranial mass, hemorrhage or restricted diffusion to suggest acute infarct is seen. Ventricles and basal cisterns are symmetric and appear within normal limits. Cerebellar tonsils are low measuring up to 6 mm below the foramen magnum with preserved rounded morphology. No abnormal parenchymal or meningeal enhancement.MRA images again demonstrate diminished caliber of the intracranial internal carotid arteries, worse on the left than the right and are occluded bilaterally similar to prior. Bilateral anterior and middle cerebral arteries are not also well visualized and consistent with severely diminished flow. These findings demonstrate no significant interval change. The surgical anastomoses of the superficial temporal arteries and middle cerebral arteries appear patent. Posterior circulation also demonstrates no significant change with good flow in the right vertebral and basilar arteries and poorly visualized left vertebral and right worse than left posterior cerebral arteries.There is deformity involving the right medial orbital wall with medial herniation of fat and compatible with chronic blowout fracture, new since prior. Small mucus retention cyst in the left maxillary sinus is again seen.
1. Compared to 10/28/2011, no significant change in tiny foci of T2/FLAIR hyperintensities in the frontal white matter which are nonspecific but may be related to prior ischemia. No evidence of new infarcts.2. MRA images also demonstrate no significant change included occluded distal bilateral intracranial internal carotid arteries and diminished flow of the anterior circulation of the circle of Willis. Diminutive left vertebral and posterior cerebral arteries also appear similar to prior. The STA-MCA bypass appear patent bilaterally.3. Cerebellar tonsils measure up to 6 mm below the foramen magnum compatible with a mild Chiari I. There is however preserved rounded morphology of the tonsils and absence of significant crowding at the foramen magnum. 