Hereditary hemorrhagic telangiectasia patient, access for brain AVM. There is a small focal enhancement on the right central sulcus. The lesion shows small vascular tangles indicating possible nidus is more likely located on the posterior central gyrus side with a tortuous enhancing vascular structure across the brain parenchyma and reaching to the right lateral ventricle ependymal surface. This lesion is most likely small brain AVM located on the central sulcus. Focal high signal intensity around the duct vascular tentacle on the right side posterior central gyrus with associated signal voids on gradient echo images indicate possible prior hemorrhage.There is also 18.5 mm x 26.4 mm sized extra-axial L enhancing mass on the left side paracentral lobule indicates meningioma.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Again right central sulcus vascular lesion is demonstrated.
1. Vascular lesion on the right central sulcus with nidus located on the anterior aspect of right postcentral gyrus indicating brain AVM. Possibility of prior hemorrhage is suggested.2. About 3 cm sized left paracentral local meningioma as described above. 