Diagnosis: Cerebral infarction, unspecifiedClinical question: please eval for moyamoyaSigns and Symptoms: Sickle cell trait MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are small foci of T2 and FLAIR signal hyperintensity present in the brainstem in the right thalamus. A focus of T2 and FLAIR signal hyperintensity is present in the right centrum semiovale which measures 9 x 17 mm axial dimensions and is associated with some mild exit vacuo effect on the right lateral ventricle.There are punctate foci of susceptibility present in the right thalamus and left basal ganglia as well as the right pons.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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: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 and is medium size.. The posterior communicating arteries are identified. The right posterior communicating artery is small. The left posterior communicating artery is a very small. The vertebral arteries are similar in size.There is extracranial origin of the right posterior inferior cerebellar artery.There is marrow replacement present.
1.There is no evidence for acute cerebral infarction.2.There are multiple microhemorrhages identified in the basal ganglia, thalami and brainstem which are non-specific but whose pattern suggests they are related to hypertension.3.There is a small focus of encephalomalacia in the right centrum semiovale present which is most likely vascular related.4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. They are most likely vascular related. 5.Patchy lesions in the brainstem are most likely vascular related.6.There is no evidence for intracranial cerebrovascular stenosis or moyamoya.7.Diffuse marrow replacement is likely related to patient's known sickle cell.