 MRI brain: There is no restricted diffusion to suggest acute infarct. Redemonstrated is right greater than left encephalomalacia in the ACA-MCA watershed territory and encephalomalacia in the inferior left cerebellar hemisphere, consistent with chronic infarcts. There right cerebral hemispheric volume loss with mild ex vacuo dilatation of the right lateral ventricle. There is decreased caliber of the vessels in the right cerebral hemisphere. There are punctate and curvilinear foci of susceptibility artifact in the left cerebellar hemisphere, consistent with hemosiderin deposition from chronic hemorrhagic infarct. There is also a small focus of susceptibility artifact in the left temporal lobe, consistent with hemosiderin deposition. There is a small retention cyst in the right maxillary sinus. There is diffuse thickening of the skull, which is likely related to sickle cell disease.MRA brain: There is marked narrowing of the intracranial right internal carotid artery and right middle cerebral artery. The right M1 and right A1 segments are not visualized. The right ACA distal to the right A1/A2 junction is normal in caliber. The left ICA and M1 segments are normal in caliber. The left anterior cerebral artery is also diminished in caliber. There are multiple prominent lenticulostriate, right greater than left, as well as transcallosal and pericallosal collateral vessels. There is asymmetrically diminished caliber of the right MCA cortical branches. The right distal ACA, PCOM and PCA and left MCA and PCA and their distal branches are mildly dilated in caliber. The basilar artery and imaged portions of the vertebral arteries appear unremarkable. There is no evidence of cerebral aneurysms.
1. Findings compatible with Moya Moya disease in the setting of sickle cell anemia, more severely affecting the right sided cerebral vasculature. No significant change since 1/29/2014.2. No evidence of acute infarct. Chronic infarcts in the ACA-MCA watershed territories, right greater than left, and left PICA territory.