Other amnesia [R41.3] / Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter [S06.6X9A], Reason for Study: ^Reason: please evaluate for subdural hematoma History: Daily headaches on xeralto, ?subdural on CT Brain MRIProminent CSF space around the left cerebellar hemisphere is shown corresponding to prior CT scan. There is no associated parenchymal (left cerebellar hemisphere) volume loss. Since there is no evidence of blood products, the chance of subdural hematoma is unlikely, thus this likely represent enlarged CSF space or arachnoid cyst. No evidence of acute ischemic or hemorrhagic lesion on the scan.Multiple scattered high signal intensity lesions on T2/FLAIR on bilateral periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. 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 multifocal luminal stenosis of intracranial arterial system especially bilateral PCAs and MCAs indicating intracranial atherosclerosis. Distal right vertebral artery shows about 30-40% luminal stenosis. The left vertebral artery is hypoplastic.There is no evidence of intracranial arterial aneurysm.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The left vertebral artery arises from the aortic arch and left subclavian artery junction and appears to be hypoplastic. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. No evidence of acute ischemic or hemorrhagic lesion. 2. Non specific small vessel ischemic disease.3. Mild atherosclerotic changes of intracranial arterial system. No occlusion of major vessel. No aneurysm.4. Normal neck MRA except hypoplastic left vertebral artery. 