74 years Female (DOB:2/22/1942)Reason: new lung cancer diagnosis, initial staging History: n/aPROVIDER/ATTENDING NAME: JYOTI D PATEL JYOTI D PATEL There is susceptibility effect along the surface of the right frontal lobe representing siderosis. There is encephalomalacia involving the right inferior parietal lobule and the posterior aspect of the right temporal lobe and posterior lateral aspect of the right occipital lobe. There is associated ex vacuo effect along the right lateral ventricle.There are numerous serpiginous flow-voids centered in the right cerebellar hemisphere associated with a large draining vein. The serpiginous flow-voids encompasses an area measuring approximately 11 x 7 mm axial dimensions.The right middle cerebral artery is not readily identified. The left middle cerebral artery appears attenuated distal to the mid M1 segment. The left anterior cerebral artery appears attenuated proximally. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal right anterior and left posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. Findings suggest fetal origin of the right posterior cerebral artery with a small right P1 segment and stenosis or occlusion at the p2 segment and a fairly large left posterior cerebral artery with a large left posterior communicating artery. Findings also suggest leptomeningeal collateral reconstitution of the left anterior cerebral artery.The visualized portions of the paranasal sinuses demonstrate small 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.
1.Findings are suggestive of occlusion of the right middle cerebral artery and high-grade stenoses along the proximal left anterior cerebral artery and stenosis along the left middle cerebral artery as well as stenosis or occlusion of the right posterior cerebral artery at the P2 segment. If clinically appropriate an MR angiogram or CT angiogram may be helpful to further evaluate this. Leptomeningeal reconstitution of the anterior cerebral artery territory and possibly left middle cerebral artery territory are suggestive of misery perfusion.2.Findings raise the question of small arteriovenous malformation versus developmental venous anomaly located in the right cerebellar hemisphere. An MRA or a CTA may be helpful to further evaluate this.3.There is encephalomalacia involving much of the right cerebral hemisphere predominantly along the right middle and posterior cerebral artery territories.4.Siderosis along the right frontal lobe implies prior subarachnoid hemorrhage.5.Findings were discussed with Dr Jyoti Patel at the time of this interpretation.