14 years Female (DOB:1/9/2002)Reason: r/o signs of vasculitis, i.e. SLE History: autoimmune hepatitis with withdrawn, depressed affectPROVIDER/ATTENDING NAME: RUBA K. AZZAM RUBA K. AZZAM MRI of the brainThere is diffusion restriction present along the subcortical white matter of the frontal and parietal lobes and temporal lobes as well as within the corpus callosum and tectal plate. The pattern is very symmetric.There is T1 hyperintense signal present along the basal ganglia bilaterally.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 are clear. 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. In the peripheral vasculature, there is an appearance of smooth narrowing of some of the peripheral vasculature.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. There is fetal origin of the posterior cerebral arteries bilaterally. The left P1 segment is slightly smaller than the posterior communicating artery whereas the right P1 segment is much smaller. The vertebral arteries are similar in size.
1.Foci of confluent diffusion restriction are present in the subcortical white matter of the frontal, parietal and temporal lobes and corpus callosum as well as the tectal plate and posterior brainstem. This a fairly symmetric pattern which would be more consistent with toxic/metabolic cause such as neurotoxicity from pharmacologic agents, leukoencephalopathy and possibly hepatic encephalopathy (given the clinical history). Vasculitis, although conceivable as a cause of this pattern, tends to be associated with asymmetric lesions.2.Lesions within the globus pallidus bilaterally suggestive of chronic liver failure.3.The possibility of vasculitis cannot be excluded.4.Mastoid air cell and middle ear opacification is a nonspecific finding which could relate to retained secretions.