Neurofibromatosis, type 1 [Q85.01] / Localization-related (focal) (partial) symptomatic epilepsy and epileptic syndromes with complex partial seizures, intractable, without status epilepticus [G40.219] / Moyamoya disease [I67.5], Reason for Study: ^Reason Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion.There are extensive likely chronic ischemic stroke related encephalomalacia involving right frontal, right parietal, right temporal, right occipital lobe, left temporal and left occipital lobes with ex vacuo changes of bilateral lateral ventricle. No change since prior scan.There is no mass, mass effect, edema, midline shift, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate complete occlusion of bilateral distal ICAs, the right ICA occluded after the origin of the right ophthalmic artery and the right Pcom artery, and the left ICA is occluded after the left Pcom artery origin. The left ophthalmic artery is not clearly visualized.Bilateral ECA branches likely superficial temporal arteries cross through the bilateral temporal bone craniotomy site and appear to be connected to bilateral MCA M3 segments. Bilateral distal M1 segment of MCAs were visualized likely through retrograde fashion. Bilateral distal ACAs are visualized but bilateral ACA A1 segments are not seen.Vertebrobasilar system including bilateral PCAs were seen and the left distal Vertebral artery appears to be hypoplastic.No evidence of intracranial aneurysm.Comparing to prior MRA, there is no significant interval change.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Extensive bihemispheric encephalomalacia likely due to prior ischemic infarctions with ex vacuo changes, no change since prior scan.3. Post EC-IC bypass surgery status with patent bypass grafts.4. No change of MRA findings since prior scan. 