 There is no evidence of acute ischemic or hemorrhagic lesion on this scan.FLAIR images show a bit prominent bilateral frontal lobe cortices, however, these findings are likely to be related to 3T machine related artifacts.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal arterial luminal caliber without evidence of intracranial arterial luminal irregularities or aneurysm.Acom artery is patent and bilateral Pcom arteries are patent too.The distal right vertebral artery shows localized fenestration as well as double lumen indicating arterial dissection. (series 501, image 18/200).3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate irregularities of bilateral distal vertebral arteries indicating vertebral arterial dissection bilaterally. In particular, on the right side the C1 arch level right vertebral artery shows focal signal loss with luminal irregularity and on the left side, the left vertebral artery shows long segment irregularity of the vertebral artery from around C4 to C2 vertebral level. There is no evidence of intraluminal filling defects on this MRA.Otherwise bilateral common carotid arteries with bifurcations and all major arch vessels appear to be normal.
1. No evidence of acute ischemic or hemorrhagic lesion on this scan.2. MR evidence of bilateral distal vertebral artery dissection without evidence of intraluminal filling defect. The age of these vertebral dissection is undetermined but MRI with axial fat saturated T1 scan may provide some clue for the age of the dissection.Comment: Subclinical angiographic luminal narrowings or irregularities due to craniocervical dissection tends to get angiographic recovery in 30-40 days, therefore, follow up MR angiography of neck in 2 months can be considered if clinically indicated. Above findings and management related issues have discussed with Dr.Kelly at the time of this dictation. 