53 year-old female status post aneurysm clipping with known cerebral cavernous malformation disease. The patient is experiencing right arm ulnar palsy and atrophy as well as right leg pain. Brain MRI:Redemonstrated are postsurgical changes from a left-sided craniotomy for placement of an aneurysm clip in the region of the anterior communicating artery. Susceptibility from the aneurysm clip obscures local structures.Encephalomalacia with adjacent gliosis is noted involving the anterior left temporal lobe, consistent with evolution of previously demonstrated vasogenic edema involving the anterior temporal lobe.Redemonstrated are a few scattered punctate foci of T2 hyperintensity primarily in subcortical white matter locations without associated mass effect, restricted diffusion, enhancement, or susceptibility abnormality. These are unchanged in appearance.There are no new masses, mass effect, or midline shift. Ventricular sizes are within normal limits.Redemonstrated is susceptibility artifact involving the left occipital lobe, unchanged in appearance, without associated perilesional edema. Additionally, enhancement images demonstrate an associated developmental venous anomaly. A small rounded focus of susceptibility is again noted involving the posterolateral right putamen, without associated developmental venous anomaly, and without perilesional edema, unchanged in appearance. There are no other foci of subcutaneous susceptibility abnormality.Paranasal sinuses and mastoid air cells remain clear. Orbital contents remain unremarkable.Brain MRA:Artifacts from the aneurysm clip obscures visualization circle of adjacent Willis including the proximal left ACA and MCA. There is normal flow enhancement in vertebral-basilar arteries (posterior-inferior cerebellar, anterior-inferior cerebellar, and superior cerebellar arteries) and distal intracranial vasculature.
1.Encephalomalacia with adjacent gliosis is noted involving the anterior left temporal lobe, consistent with evolution of previously demonstrated vasogenic edema involving the anterior temporal lobe.2.Stable susceptibility artifact involving the left occipital lobe is consistent with a cavernous malformation, without lesional edema, with an associated developmental venous anomaly. 3.A small rounded focus of susceptibility is again noted involving the posterolateral right putamen, without associated developmental venous anomaly, and without perilesional edema, unchanged in appearance. This may represent a tiny cavernous malformation versus mineralization or prior microhemorrhage.4.Unremarkable MRA brain apart from artifacts from the aneurysm clip obscuring visualization circle of Willis and proximal left ACA and MCA. 