 MRI brain: Brain parenchyma demonstrates scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There is no evidence of restricted diffusion. No susceptibility changes to indicate intracranial hemorrhage. There is mild parenchymal volume loss involving the bilateral parietal lobes and cerebellum. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified. There is mild-to-moderate opacification of the left mastoid air cells.MRA: There is asymmetric enlargement of the right inferior petrosal sinus as well as small vascular structures which may represent small arterial feeders from the ascending pharyngeal artery/external carotid artery branches medial to the internal carotid artery at the level of right occipital condyle.There is a questionable 2 mm enhancement at the level of right proximal cavernous segment of ICA (image 55, series 501) which is favored to be related to adjacent vessel rather than a tiny posterior directly aneurysm. No aneurysm is appreciable on outside conventional angiogram. Otherwise, intracranial internal carotid arteries are normal in course and caliber without flow-limiting stenosis or occlusion. The middle and anterior cerebral arteries unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or aneurysm.Please note MRA neck and MRV was not obtained during the study.Cervical spine: Please note examination is performed as MRI cervical spine as requested. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body are well-maintained. There are degenerative disc changes with loss of height of C5-C6 and C6-C7 disc spaces. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is facet arthropathy. No significant compromise to the spinal canal or neural foramina.C4-5: Mild osteophyte disc complex with ligamentum flavum thickening and mild facet arthropathy resulting in minimal narrowing of the spinal canal. There is minimal left neural foraminal narrowing.C5-6: Posterior osteophyte disc complex and ligamentum flavum thickening resulting in minimal right neuroforaminal narrowing. There is minimal spinal canal stenosis.C6-7: Minimal posterior osteophyte disc complex. There is ligamentum flavum thickening. There is is minimal spinal canal stenosis. Minimal bilateral neural foraminal narrowing.C7-T1: There is facet arthropathy and ligament flavum thickening resulting in minimal left neuroforaminal narrowing. No significant compromise to the spinal canal.Post contrast sequences demonstrates no abnormal enhancement or abnormal flow voids within the spinal canal. Paraspinous soft tissue structures appear within normal limits.
1. Asymmetric enlargement of the inferior petrosal sinus with additional vascular structures medial to the internal carotid artery at the level of the right occipital condyle which may represent arterial feeders from external carotid artery branches (probably ascending pharyngeal artery) and corresponding to known dural AV fistula, which was better assessed on prior conventional angiogram. Allowing for slight differences in technique, there is no interval change since prior MRI/MRA.2. Mild chronic small vessel ischemic changes and mild volume loss. Brain parenchyma is otherwise unremarkable.3. Mild degenerative changes in the cervical spine as detailed above. No abnormal flow-voids within the spinal canal are appreciated.