 MRI BRAIN: There is focus of diffusion hyperintensity in the right parietal subcortical white matter with suggestion of some areas with high ADC and low ADC. As such this may represent a subacute infarct. Otherwise no restricted diffusion in the remainder of the brain and no evidence of parenchymal edema. No intracranial mass or mass effect.Again seen is susceptibility artifact related to subdural hemorrhage involving the posterior falx and bilateral tentorial leaflets. Component of the subdural hemorrhage also demonstrates T1 hyperintensity.No evidence of intracranial mass effect. No hydrocephalus. Paranasal sinuses and mastoid air cells are clear. Bone marrow signal and extracranial soft tissues are unremarkable.MRA BRAIN:There is intracranial internal carotid arteries are widely patent with no evidence of aneurysm or flow-limiting stenosis. The anterior, posterior, and middle cerebral arteries are widely patent. There is normal circle of Willis. The basilar artery and the bilateral vertebral arteries are widely patent. MRV BRAIN:MR venogram is technically limited and not adequate to exclude thrombosis. Major dural venous flow voids are not clearly identified to confirm patency.
1. Subdural hemorrhage along the falx and tentorial leaflets is again seen. No associated mass effect.2. Small focus of diffusion hyperintensity and T2/FLAIR hyperintensity with some component suggesting low ADC although part of it is definitely high on ADC. As such this may represent a subacute infarct. No definite evidence of acute infarcts in the remainder of the brain.3. No evidence of parenchymal hemorrhage or parenchymal edema. MR venogram is technically limited and not adequate to exclude thrombosis. Major dural venous flow voids are not clearly identified to confirm patency. Recommend MR venogram with contrast with inclusion of postgadolinium 3D FSPGR sequence to exclude venous sinus thrombosis.4. MRA demonstrates no evidence of flow-limiting stenosis or aneurysms in the intracranial circulation.Dr. Ali discussed findings with Dr.Derani at 925 hrs on 9/6/2015I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.