23 years Female (DOB:4/27/1993)Reason: s/p AVM resection and SRS, please evaluate for changes, 3T scanner History: yearly surveillance, seizuresPROVIDER/ATTENDING NAME: ISSAM A. AWAD SERVICES ANCILLARY MRI of the brainNo diffusion weighted abnormalities are appreciated.The patient is status post left-sided craniotomy for removal of an arteriovenous malformation. Some signal changes at the surgical bed likely represent gliotic changesThere is a small tangle of flow voids present in the right perimesencephalic cistern and in the right geniculate nucleus. There is associated enhancement at the right geniculate nucleus which has decreased compared to the prior exam. This focus of enhancement currently measures 9 x 4 mm axial dimensions and previously measured 13 x 6 mm axial dimensions on the 11th/2/15 exam. On susceptibility imaging there is signal loss at the area of contrast enhancement. Associated FLAIR signal hyperintensity is also regressedA punctate microhemorrhage is present in the left middle frontal gyrus. This is stable when compared to the prior examThe visualized portions of the paranasal sinuses demonstrate a small mucus retention cyst in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. 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.There is a small tangle of vascular structures centered in the expected location of the right geniculate nucleus associated with mild enlargement of the the thalamogeniculate branches of the right posterior cerebral artery. These are less prominent than on the previous exams. The right medial atrial vein is asymmetrically larger than the left medial atrial vein.The anterior communicating artery is medium-sized. The posterior communicating arteries are small. The vertebral arteries are similar in size.
1.Status post removal of left temporal lobe arteriovenous malformation with expected post treatment change.2.A previously identified and treated arteriovenous malformation centered in the right geniculate nucleus continues to regress. Given some asymmetry in the size of the medial atrial veins this may represent indirect evidence that it hasn't resolved completely. Contrast enhancement and T2 to signal hyperintensity within the radiation bed continues to regress and is likely related to posttreatment change.