19 years Male (DOB:1/1/1997)Reason: sickle cell anemia, history of Moya Moya History: surveillancePROVIDER/ATTENDING NAME: ELIZABETH M DRUMM ELIZABETH M DRUMM 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 are multiple punctate T2 and FLAIR hyperintense foci between the anterior and middle cerebral artery territories within the subcortical and periventricular white matter. These were also present on the prior exam. These are stable compared to the prior exam.No significant perfusion delay is hypoperfusion is appreciated in the anterior cerebral artery territories are the posterior cerebral artery territoriesNo 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 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:The current MR angiogram was performed on a 1.5 Tesla MRI unit with a low spatial resolution whereas the prior MR angiogram was performed on a 3 Tesla magnet with a high spatial resolution. There is significant difference in spatial resolution between the 2 studies.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal middle and posterior cerebral arteries.The A1 segments are occluded at their origin and reconstituted distally.There is a stenosis present at the left posterior cerebral artery at the proximal P2 segment.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The right posterior communicating arteries is medium-sized. The left posterior communicating artery is very small. The left vertebral artery is larger than the right vertebral artery.
1.There is occlusion of the anterior cerebral artery A1 segments proximally with distal reconstitution. This was also identified on the prior exam. Please note that there are spatial resolution limitations on the current exam which were not present on the prior exam making assessment for interval change slightly less reliable.2.There is a stenosis suspected of the left posterior cerebral artery at the proximal P2 segment was not present on the prior exam3.There is no hypoperfusion on the basis of perfusion exam..4.Punctate lesions in the watershed zones between the anterior middle cerebral artery territories are stable and most likely related to ischemia.