42 years Male (DOB:1/25/1974)Reason: spontaneous subdural hematoma that had resolved, now with new headaches, please compare to prior imaging History: headachesPROVIDER/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 enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. There is some mild thickening of the right the dura along the superior aspect of the head.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.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are small. The left posterior communicating artery is much smaller than the right posterior communicating artery. The vertebral arteries are similar in size.There are some mild asymmetry in the size of the middle meningeal artery - the right being slightly larger than the left. This is a nonspecific finding no transcortical vasculature is identified on this exam though the top half of the head is not included on the 3-D time-of-flight.MRV brain:The left transverse sinus, sigmoid sinus and jugular veins are smaller than the right-sided counterparts. Recent CTs of the head demonstrated at the left jugular bulb and left sigmoid sinus groove are smaller than the right-sided counterparts indicating this asymmetry is congenital.The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The left vein of Labbe is larger probably related to asymmetry in the venous drainage between the 2 hemispheres.There is asymmetry in the size of the superficial temporal veins with the right being larger than the left. No transcortical vasculature is identified.
1.Some mild thickening at the superior aspect of the intracranial dura on the right is present. This is a nonspecific finding and could represent reparative phase to the prior hematoma. Please correlate with patient's clinical history and imaging demonstrating prior subdural hematoma.2.Asymmetry in the size of the middle meningeal arteries. This is a nonspecific finding. Please note that the entire head was not included on the MRA exam. One possibility is that this may be related to meningeal reaction on the right side.3.There is no evidence for intracranial aneurysm or intracranial cerebrovascular occlusive disease4.There is no evidence for intracranial sinus thrombosis. Asymmetry in the size of the left transverse sinus, sigmoid sinus and jugular vein is most likely congenital.