 Brain MRI:No restricted diffusion to indicate an acute ischemic infarct. No susceptibility abnormalities to indicate hemorrhage. No mass, mass effect, midline shift of herniation. There is minimal periventricular white matter T2 hyperintensity. The brain parenchyma otherwise appears unremarkable. There is no abnormal intracranial enhancement. The ventricles and sulci are unchanged. There is no midline shift or herniation. The major cerebral flow voids are intact. There are retention cysts in the sphenoid sinuses. The skull and scalp soft tissues are unremarkable. There is a partially-imaged cystic lesion in the right maxillary alveolus which is unchanged.Brain MRA: There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. No arterial stenoses, occlusions or aneurysms are identified within the brain. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis. Neck MRA:The right vertebral artery is hypoplastic and there is a focal 8 mm region of luminal narrowing in the V3 segment which suggests a possible dissection. The carotid and left vertebral arteries are of normal caliber without evidence of dissection or aneurysm.
1.No evidence of acute intracranial hemorrhage or mass.2.No evidence of steno-occlusive disease or aneurysm in the arteries of the brain3.The right vertebral artery is hypoplastic and there is a focal 8 mm region of luminal narrowing in the V3 segment which suggests a possible dissection. A CTA of the neck would provide further information if clinically warranted. 4.Findings discussed with Dr. Eric Toone (# 4305) of the PICU service by phone by Dr. Michael Veronesi of the Radiology service at the time of this final entry.