21 years Male (DOB:11/19/1994)Reason: Evaluate for etiology of L sided headaches, episode of L sided numbness and weakness History: L sided headaches after head trauma, episode of L sided numbness and weaknessPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The cerebellar tonsils extend 3-4mm below the level of the foramen magnum.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing 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 anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate small mucous retention cysts in the right maxillary and ethmoid air cells and to a lesser degree left maxillary sinus The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. Asymmetric mucosal thickening in the right nasal cavity is not entirely attributable in part to nasal cycling. Findings suggest that polypoid mucosal thickening may be present.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 and is medium size. The posterior communicating arteries are intact and very small. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. Fat sat axial and coronal imaging were performed following contrast. Presence of contrast confounds the evaluation for a subtle dissection on these sequences. The 2DTOF and 3DTOF sequences reveal no evidence for vertebral or carotid dissection.
1.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for cerebral hemorrhage.3.The cerebellar tonsils are low lying and borderline for Chiari 1 malformation. There is no evidence for ventriculomegaly.4.Mucosal thickening in the right nasal cavity is non-specific. The possibility of a small polypoid lesion such as a nasal polyp or other polypoid lesion cannot be excluded. If clinically appropriate, direct visualization may be helpful. The pattern of adjacent right maxillary and ethmoid mucosal thickening suggests this may be obstructive.