53 years Male (DOB:8/21/1963)Reason: 3T Scanner, aneurysm surveillance one year, s/p SAH and EVD placement/removal in 2015 History: 3T Scanner, aneurysm surveillance one year, s/p SAH and EVD placement/removal in 2015PROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD 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 is a focus of susceptibility effect present along the central portion of the midbrain which measures approximately 14 x 4 mm axial dimensions on FLAIR imaging. It is stable compared to the prior exam. There is no new extension of this hematoma.A ventriculostomy tract courses through the right frontal lobe into the right lateral ventricle .There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. These are stable compared to the 8/14/2015 exam. Some patchy T2 and FLAIR signal hyperintensities in the brainstem are also stable compared to the prior exam.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 are clear. 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.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.Incidental note is made of dorsal origin of the left ophthalmic artery from the cavernous segment of the left internal carotid artery.The right v4 segment distal to the origin of the right PICA is hypoplastic.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.There is a chronic stage hemorrhagic focus present in the midbrain which is stable since last year.4.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, or sarcoid. They are nonspecific. 