Diagnosis: Sickle-cell disease without crisisClinical question: sickle cell dsSigns and Symptoms: eval Moya Moya or stenosis 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 demonstrate minor opacity left maxillary sinus which are unchanged. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells. This finding was present on the prior exam and has not changed. The visualized portions of the orbits are intact.There is diffuse calvarial thickening present and diffuse marrow replacement.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 extracranial origin of the posterior inferior cerebellar artery bilaterally.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The right posterior communicating arteries are identified and are large.. The vertebral arteries are similar in size.
1.There is no evidence for intracranial cerebrovascular occlusive disease. There is no evidence for moyamoya. Compared to the prior exam there is no interval change. Previously noted mild narrowing of the left middle cerebral artery can be accounted for on the basis of time-of-flight artifact.2.Diffuse calvarial thickening and marrow replacement can be accounted for on the basis of the patient's sickle cell disease