Recent history of subarachnoid hemorrhage. Evaluate for etiology of the subarachnoid hemorrhage. MRI Brain:The previously described subarachnoid hemorrhage is not readily seen on today's exam. Note is made of a right frontal approach ventriculostomy drain which terminates in the right foramen of Monroe. The ventricles are mildly enlarged but unchanged compared to the previous head CT. Incidental note is made of a punctate focus of diffusion restriction in the right parieto-occipital white matter corresponds with a T2/FLAIR signal abnormality and is a nonspecific finding. No other parenchymal abnormalities are noted. The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 clear. The visualized portions of the orbits are intact.MRI C-Spine: Limited study of the cervical spine which includes only sagittal T1 and T2 images.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. No significant compromise to the spinal canal or neural foramina. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.
1.Limited study with early termination per patient request who reported claustrophobia as described in detail above in the technique section. No post contrast imaging was performed and no axial imaging of the cervical spine was performed. This limits evaluation.2.There is not evidence for AVM, intracranial mass or other potential source for hemorrhage.3.An acute microinfarct is present in the right parietal lobe white matter.4.The previous SAH is not readily appreciated on today's exam.5.Right frontal approach ventriculostomy drain and stable mild enlargement of the ventricles.6.Normal appearing cervical spine MRI, although only sagittal T1 and T2 images were available for review.