66 years Female (DOB:11/29/1949)Reason: please evaluate AVfistula for changes, prior to SRS History: Pulsatile tinnitus (has improved since last scan)PROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD MRI of the brainNo diffusion weighted abnormalities are appreciated.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.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 no evidence for intracranial aneurysm or cerebrovascular occlusion.There is a redemonstration of an asymmetrically prominent right hypoglossal artery branch of the ascending pharyngeal artery when compared to the left side. The hypoglossal branch appears to anastomose with the odontoid arch system.. Then goes on to anastomose with the C2 artery. The previously noted prominence of the inferior petrosal sinus is not present on the current exam.There is prominence of the clival branch of the right meningohypophyseal trunk of the right internal carotid artery.The anterior communicating artery is identified. An incompletely visualized vessel originating from the ACOMA is suspected to represent the median artery. The anterior communicating artery is large. This appearance has not changed since the prior exam dilated component of the anterior communicating artery The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size.There is extracranial origin of the posterior inferior cerebellar artery bilaterally.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.A large right hypoglossal branch of the ascending pharyngeal artery is present. This is a nonspecific finding. There is no convincing evidence for arteriovenous fistula or vascular lesion. Other explanations may be collateralization or congenital cause or a vascular lesion below the field-of-view on this exam. The change since the prior exam could imply a decrease in flow from a prior lesion.