Other musculoskeletal symptoms referable to limbs(729.89) [729.89] / Moyamoya disease [437.5] / Facial weakness [781.94], Reason for Study: ^Reason: evaluate for new stroke History: moyamoya pt with new r face and L arm weakness, bowel/bladder incontinence Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on this scan.There are multifocal tissue losses, encephalomalacia include bilateral frontal lobes, left parietal lobe, left temporal lobe, left occipital lobe and left insular with ex vacuo change of the left lateral ventricle.There are multiple small signal voids around suprasellar cistern, ambient cistern, interpeduncular cistern and quadrigeminal cistern indicating small collateral vessels, Moya Moya vessels.Comparing to prior scan performed on July 2007, there are no significant interval difference in terms of the extent of encephalomalacia, the degree of Moya Moya vessels and the degree of ex vacuo change of the left lateral ventricle.The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate no MR evidence of normal inflow enhancement on bilateral distal ICAs especially from the level of bilateral ophthalmic arteries. Bilateral MCAs' M1 segments are not visualized as well as bilateral ACA A1 segments. The right ACA appears to be reconstituted at the level of the corpus callosum genus portion. Bilateral ICAs were visualized, although small in diameter, upto the level of the proximal cavernous sinus segment.The vertebral basilar system appears to be normal in diameter. However, there are numerous small flow related enhancements on cisterns spaces especially quadrigeminal, ambient, interpeduncular, and suprasellar cisterns. In addition, there are numerous small flow related enhancements on bilateral midbrain, pons and basal ganglia indicating collateral vessels (Moya Moya vessels). No significant interval change since prior scan.No evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate severely narrowed but still patent bilateral extracranial ICAs especially from CCA bifurcations.Right vertebral artery appears to be smaller and somewhat luminal irregularity. This finding most likely represent congenital hypoplasia. The left vertebral artery appears to be normal.Bilateral CCAs are slightly smaller in diameter without focal stenosis.Bilateral subclavian arteries are normal.
1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. Multifocal chronic ischemic infarction with encephalomalacia as described above, no change since prior scan.3. Severe stenosis of bilateral ICAs from the level of CCA bifurcation to the level of proximal cavernous sinus segment then appear to be completely occluded. No change since prior scan. 4. Vertebrobasilar system appears to be normal with the right vertebral artery is hypoplastic.5. Numerous development of MoyaMoya vessels as described above, no change of its extent and degree since prior exam. 