Diagnosis: Other specified congenital anomalies of brainClinical question: s/p intervention/embolization/SRS treatment of left dural AV fistulaSigns and Symptoms: surveillanceComments: Needs labs due to HTN | MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.MRA brain:Compared to the previous exam the left external carotid artery vasculature has decreased in caliber. Additionally, the number of vessels extending into the left sigmoid sinus have substantially regressed. The left mastoid artery can be identified extending into the left sigmoid sinus of remaining in the other vessels are not readily appreciated.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 right posterior communicating artery is medium-sized. The left posterior communicating artery is tiny. The anterior communicating artery is small. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery.
1.Compared the previous examination, there has been substantial reduction in the patient's left-sided arteriovenous fistula. There is some evidence that a small supply to the fistula still exists.2.Periventricular and subcortical white matter changes of a mild degree are nonspecific.