56 years Female (DOB:1/11/1960)Reason: Patient w/ hx of CVA s/p VP shunt, w/ AMS, eval for CVA/ vascular occlusion/ hemorrhage History: As abovePROVIDER/ATTENDING NAME: MICHELLE K MARTINCHEK MICHELLE K MARTINCHEK MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. The ventriculostomy tube courses the right parietal calvarium through the right central sulcus into the right lateral ventricle with tip in the frontal horn of the right lateral ventricle.A ventriculostomy tract course of the right frontal lobe.There are a couple periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are T2 and FLAIR hyperintense patchy foci within the brainstem.There is abnormal signal along the medial aspect of the right cerebellar hemisphere similar to the prior exam. There is associated susceptibility effect within this cerebellar lesion.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 redemonstrate a mucous retention cyst in the right maxillary sinus. 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. The left A1 segment is larger than the right A1 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.There is extracranial origin of the posterior inferior cerebellar arteries bilaterally.There is suspected meningeal thickening present which is stable since the prior exam.
1.A right cerebellar lesion might likely represent prior vascular injury associated with hemorrhage. This is stable since the prior exam.2.Ventriculostomy tube is in place.3.There is no evidence for intracranial cerebrovascular occlusive disease.4.There are bilateral ventricular shunts present without evidence for ventriculomegaly.5.There is redemonstration and no change in pachymeningeal thickening. One possibility is that it is related to the ventricular shunts.