63 year old male with cavernous malformation. Redemonstrated is a left hemispheric frontal tumor cavernous malformation, unchanged in size or shape. As before, there is no perilesional edema and there is no associated mass effect.Redemonstrated is a slight prominence of bilateral hemispheric cortical sulci which could be still within limits of normal for patient's stated age. There are a few punctate foci of increased T2 signal intensity in the subcortical and periventricular white matter as well as within the left thalamus which are unchanged and consistent with chronic small vessel ischemic disease. As before, there are foci of encephalomalacia with gliosis involving the distribution of bilateral PCA consistent with remote ischemic strokes. There is a well-demarcated focus of increased T2 and decreased FLAIR signal in the right paramedian posterior pons which in combination with additional small foci of similar signal changes in bilateral cerebellum (left greater than right) are consistent with chronic ischemic changes in the distribution of the vertebro-basilar system, unchanged in appearance.There is no restricted diffusion to suggest the presence of acute ischemia. Previously demonstrated lack of flow within the distal left vertebral artery is again noted. Otherwise expected vascular flow voids are demonstrated. Post enhanced images demonstrate no abnormal enhancement of brain parenchyma or the leptomeninges and no convincing enhancement of the cervical cavernous malformation.Redemonstrated is sinus disease within the maxillary sinuses (left greater than right). The remaining visualized paranasal sinuses as well as the mastoid air cells are clear.
1.Stable left frontal cavernous malformation without perilesional edema or mass effect.2.Stable mild chronic small vessel ischemic disease, large left PCA and a smaller right PCA chronic remote ischemic strokes, small bilateral cerebellar chronic strokes, and a right paramedian pontine chronic lacunar infarct.