59 years Female (DOB:1/10/1957)Reason: eval for PRES History: eval for PRESPROVIDER/ATTENDING NAME: CHRISTOPHER L KRAMER CHRISTOPHER L KRAMER MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post left sided craniotomy. There is a hemorrhagic focus present in the left posterior frontal lobe measuring approximately 28 x 27 mm axial dimensions which is associated with fluid fluid levels and associated vasogenic edema. Another hemorrhagic lesion is present in the left occipital pole measuring approximately 25 x 14 mm axial dimensions which is also associated with some vasogenic edema.There is T2 hyperintensity of the gray-white interface at the occipital lobes and watershed regions of the frontal and parietal lobes associated some signal changes.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 are clear. The visualized portions of the mastoid air cells are clear. 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.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. 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. MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The anterior aspect of the superior sagittal sinus appears small but patent. There appears to be a filling defect at the site of change in caliber which corresponds to craniotomy site as well.
1.The pattern of hypodensities in the frontal lobes, occipital lobes and parietal lobes extending of the temporal lobes as well could be related to posterior reversible encephalopathy syndrome. RCVS is less likely given the relative lack of intracranial vasoconstriction.2.Redemonstration of hemorrhagic foci centered in the left posterior frontal lobe and left occipital pole. The patient is status post surgery for the left frontal lobe hematoma.3.No evidence for intracranial cerebrovascular occlusion or significant constriction is appreciated on this exam.4.The superior sagittal sinus appears narrowed at the craniotomy site one possibility is that this is a result of postsurgical change in appearance. Arachnoid granulation could have a similar appearance as can intraluminal thrombus. Changing caliber at this site suggests that this may have some effect on superior sagittal sinus flow.