Diagnosis: Cerebral infarction, unspecified Hb-SS disease with crisis, unspecifiedClinical question: s/p stroke. Hgb SS. Evaluate for strokeSigns and Symptoms: worsening left arm and leg weakness. MRI of the brainNo diffusion weighted abnormalities suggestive of acute infarction are appreciated.There is redemonstration of encephalomalacia involving the watershed zone of the right anterior and middle cerebral artery territories with additional involvement of the right middle frontal gyrus and extension to the centrum semiovale. There is a smaller focus of encephalomalacia involving a small portion of the posterior aspect of the right temporal lobe. There is associated ex vacuo effect along the right lateral ventricle. There is redemonstration of small foci of susceptibility effect within the encephalomalacic brain.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 demonstrate some mucosal thickening along the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.A small 6mm cyst is present in the pharyngeal mucosal space to the right of midline in the nasopharynx which is likely benign.Cervical spine:There is redemonstration and no change in os odontoideum.The cervical vertebral bodies are appropriate in overall height. The cervical spinal cord has normal signal characteristics and overall morphology. There is diffuse marrow replacement.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be 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. Attenuation of right MCA vasculature is likely related to encephalomalacia.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The left vertebral artery is a little larger than the right vertebral artery.There is extracranial origin of the left PICA.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.There is redemonstration of encephalomalacia involving the right hemisphere at or adjacent to watershed territories of the right frontal, parietal and temporal lobe.2.There is redemonstration and no change in os odontoideum. Extension/Flexion plain films may help assess for instability.3.There is no evidence for intracranial cerebrovascular occlusive disease.4.There is no evidence for extracranial cerebrovascular occlusive disease.5.There is diffuse marrow replacement present which is likely related to the patient's sickle cell anemia.