42 years Male (DOB:9/24/1973)Reason: s/p SRS for AVM, radiation changes History: Please evaluate radiation changesPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainA couple punctate foci of diffusion restriction are present in the right hemispheric subcortical and periventricular white matter.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a heterogeneous lesion located in the left postcentral gyrus laterally which was also present on the prior exam. It is associated with small serpiginous signal voids laterally and the cystic component medially. There is surrounding T2 and FLAIR signal hyperintensities in the adjacent subcortical white matter in the region measuring approximately 42 x 34 mm axial dimensions. There are small foci of contrast enhancement on the T1 postcontrast images scattered within this area of T2 and FLAIR signal hyperintensity.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:There is a 9 mm arteriovenous malformation located along the left postcentral gyrus. Although much smaller than the 2012 exam it has not resolved.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. There is fetal origin of the left posterior cerebral artery associated with a hypoplastic left P1 segment. The right posterior communicating artery is not readily visualized The vertebral arteries are similar in size.
1.There is a 9mm residual AVM present along the left postcentral gyrus also identified on the 2013 exam. Since the prior exam patient has developed some contrast enhancement and some signal change surrounding the arteriovenous malformation which is suggestive of postradiation reaction.2.A couple foci of diffusion restriction the right hemisphere likely represent acute microinfarcts.