Headache(784.0) [784.0], Reason for Study: ^Reason: Vessel wall imaging eval vasculitis vs vasospasm (Discussed w/ Dr. Seon Kyu Lee) History: Abnormal findings on angiogram Brain MRI:There is no evidence of acute ischemic or hemorrhagic lesion on the scan.There is no abnormal enhancement.Multifocal intracranial arterial luminal narrowings were seen on vascular wall imaging without MR evidence of wall thickening. Although there were some motion artifacts which prevent precise comparison between pre and post enhanced images, there is no definitive evidence of wall enhancement on this scan. Though not specific, usual intracranial vasculitis can demonstrate concentric wall thickening with circumferential enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. 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. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate multifocal intracranial arterial luminal narrowings and irregularities including anterior and posterior circulations. Although limited, comparing to prior catheter angiography, there is no significant interval change since prior scan in terms of extent and degree of luminal narrowings. There is no evidence of intracranial arterial aneurysm.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Multifocal intracranial arterial luminal narrowings on both anterior and posterior circulations without evidence of wall thickening nor wall enhancement. 3. No evidence of intracranial arterial aneurysm or complete occlusion.