9 years Female (DOB:11/22/2006)Reason: Please evaluate for brainstem malformation or aneurysm History: Episodic vertigoPROVIDER/ATTENDING NAME: MICHAEL H KOHRMAN CHARLES J MARCUCCILLI MRI of the brainNo diffusion weighted abnormalities are appreciated.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 demonstrate mild mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The nasopharyngeal and oropharyngeal tonsils are symmetric and large as can often be seen at this age. 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 medium-sized. The right vertebral artery slightly larger left vertebral artery. The right anterior inferior cerebellar artery and the left posterior inferior cerebellar artery are dominant.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.
1.There is no evidence for cerebral infarction or mass.2.No evidence for intracranial cerebrovascular occlusive disease.3.No evidence for extracranial cerebrovascular occlusive disease.4.Large tonsils in a child are best evaluated on a clinical basis.