69 years Male (DOB:9/11/1947)Reason: Evaluate for etiology of L trigeminal neuralgia History: L sided trigeminal neuralgiaPROVIDER/ATTENDING NAME: THOMAS J KELLY THOMAS J KELLY MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There are a couple subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.A punctate focus of signal loss and susceptibility imaging is present in the left thalamus and another one is present in the left frontal lobe subcortical white matter.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 mucous retention cysts along the floor of the left maxillary sinus. 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 basilar artery is not adjacent to the trigeminal nerves. No sizable arterial structures are identified abutting the trigeminal nerves.The anterior communicating artery is identified. The posterior communicating arteries are identified. The left posterior communicating artery is medium-sized whereas the right posterior communicating artery is very small and the anterior communicating artery is medium-sized. The left vertebral artery is larger than the right vertebral artery.
1.No evidence for cerebrovascular occlusive disease.2.No evidence for intracranial aneurysm.3.No evidence for trigeminal nerve compression4.No evidence for intracranial mass lesion.5.A couple microhemorrhages are identified which do not have a specific pattern and are of unknown clinical significance.6.A couple subcortical white matter lesions are nonspecific and likely of little clinical significance