History of sickle cell disease and moyamoya. Visual disturbances (left blurriness/double vision) and left facial pain. Also, sinus tenderness.. The punctate and confluent frontoparietal white-matter T1-hyperintense, T1-hypointense signal has not changed. It remains more pronounced on the left. It is associated with facilitated diffusion and mild volume loss. The associated focal cortical loss and more pronounced volume loss around the left postcentral sulcus is also unchanged. There is no susceptibility artifact within the brain to reflect hemorrhage. There is no diffusion restriction to indicate acute or recent stroke. The focus of T2 hyperintensity in the left occipital periventricular white-matter is also unchanged.The left intracranial internal carotid artery remains markedly small as well as the left middle cerebral artery and its branches.The paranasal sinuses are clear for from mild posterior ethmoid mucosal thickening without fluid. The mastoid air cells and the middle ear cavities are clear as well.There is no skull destructive lesion. There are changes of previous left frontoparietal revascularization surgery in the calvarium and overlying scalp.
1.The signal abnormality involving the cerebrum, more pronounced in the left frontoparietal region, remain unchanged since February 2015. It is compatible with chronic ischemia/infarct.2.Severe narrowing of the left internal carotid artery as well as the left middle cerebral artery and its branches also remain unchanged and reflect the known sickle cell disease associated vasculopathy. 3.There is no acute/recent infarct or new brain abnormality.4.The paranasal sinuses are clear other than mild posterior ethmoid mucosal thickening without fluid.5.Left calvarial and scalp abnormalities are reflective of previous revascularization surgery.