Clinical question: Status post SRS for AVM. Evaluate and compare with January 2015 study. Signs and symptoms: As above. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination redemonstrates an enhancing arteriovenous malformation in the left superior frontal gyrus measuring at 13.7 x 9.2 mm in transaxial dimensions compared to prior study measurements of 18 x 11 mm. There is a draining vein arising from the superior aspect of the AVM and extending posteriorly and superiorly without appreciable interval change in its size. Prominent left anterior-superior vertebral artery is again identified representing feeding pedicle. There is mild gliosis surrounding the VM without change since prior exam. Additionally there are scattered foci of FLAIR and T2 hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres and minimally in the left basal ganglia without significant change since prior exam and likely representing chronic microvascular ischemic process.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.Nonenhanced brain MRA:Routine nonenhanced brain MRA is performed which does not include the region of arteriovenous malformation. Patient was notified and will return for repeat exam without additional charge. Visualized images demonstrate patent unremarkable bilateral internal carotid arteries, bilateral anterior and middle cerebral arteries. This likely larger left anterior cerebral artery likely secondary to feeding patient's known arteriovenous malformation. Unremarkable bilateral vertebral arteries, PICA branches, basilar artery and its distal branches.
1.Pre- and post enhanced brain MRI demonstrate interval decreased size of an enhancing arteriovenous malformation in the left superior frontal gyrus measuring at 13.7 x 9.2 mm compared to prior study measurement of 18 x 11. No diffusion-weighted abnormalities and stable findings of mild chronic small vessel ischemic strokes.2.MRA of intracranial circulation was performed erroneously as a routine study which does not include the entire head. Patient will return for repeat exam without additional charge. Unremarkable MRA as detailed above.