12 years Male (DOB:7/28/2004)Reason: h/o sickle cell disease, rule out CVA History: acute chest syndrome requiring intubation, developed altered mental status prior to intubatinoPROVIDER/ATTENDING NAME: DIANA LILY MITCHELL CATHERINE A. HUMIKOWSKI MRI of the brainThere are multiple foci of signal loss and susceptibility weighted imaging in the corpus callosum as well as subcortical white matter which were not evident on the prior exam. The largest one appears to be in the left parietal lobe subcortical white matter where it is also visible on routine imaging. Additional moderate-sized bones associated with the FLAIR signal hyperintensity are present in the subcortical white matter of the frontal and parietal lobes as well as the temporal lobes and occipital lobes.No abnormal 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 mucosal thickening. The visualized portions of the mastoid air cells are opacified. 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. Although the distal internal vasculature appears somewhat attenuated this is nonspecific finding there is no convincing specific vessel occlusion or stenosis appreciated.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The cerebellar tonsils remain approximate 5 mm below the level of foramen magnum and are unchanged since the prior exam.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.
1.There are numerous microhemorrhages scattered throughout subcortical white matter and the corpus callosum. Most of these are only seen on susceptibility weighted imaging. There is evidence that some of these are subacute in nature. These were not present on the prior exam from 2014. Although the cause is uncertain possibilities may include vasculopathy of sickle cell disease or a vasculitis associated with sickle cell disease. Findings were reported to Dr Tara Calhoun at the time of this interpretation.2.No evidence for cerebrovascular occlusive disease. 3.No evidence for intracranial aneurysm.