facial numbness, possible stroke No evidence of acute ischemic or hemorrhagic lesion.The right mastoid shows fluid collection which could imply possible mastoiditis. If clinically indicated, ENT consultation and dedicated temporal bone CT scan can be considered for further evaluation.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. Normal flow voids are identified in the major intracranial vessels. 3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate segmental signal loss on bilateral paraclinoid segments and proximal left MCA M1 segment on MIP images. Source image review shows linear signal void lesions were seen within the lumen which degraded MIP signal. These linear signal loss likely represent flow artifacts but may represent segmental intra luminal filling defects such as luminal irregularity or intra luminal blood clots. Thus, if clinically indicated, CT angiography can be considered for further anatomical evaluation. The proximal left MCA M1 segment lesion could represent early development of sickle cell disease related moyamoya syndrome, thus follow up MRA is recommended.Otherwise, vertebrobasilar system appears to be normal, bilateral PCAs are fetal origin, Acom artery is patent and bilateral ACAs and right MCA appear to be normal.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Likely represent artifacts for bilateral paraclinoid ICAs' segmental signal decrease. Anatomical vascular imaging such as CTA can be considered if clinically indicated.3. Subtle luminal narrowing of the left MCA proximal portion which may indicate early development of the Moyamoya syndrome, thus follow up MRA is recommended.