Diagnosis: 12-year-old male. Arteriovenous malformation of cerebral vessels Arteriovenous malformation of cerebral vesselsClinical question: evaluate changes in AVMSigns and Symptoms: increased seizure frequency, h/o of AVM s/p embolization in 10/2015 MRI of the brainThe patient is status post left parietal craniotomy for AVM removal. There is metallic artifact present at the surgical site within the left occipital and parietal lobes. This may obscure visualization of local changes. There is T2 and FLAIR signal hyperintensity in the surgical bed.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 opacification of the ethmoid air cells and sphenoid sinuses frontal sinuses and maxillary sinuses with air-fluid levels in the maxillary sinuses. Air-fluid levels were previously present in the maxillary sinuses as well.. The patient is status post intubation for the MRI. 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 anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. There is extracranial origin of the right posterior inferior cerebellar artery. There is infundibulum at the origin of the left posterior communicating artery. There is triplication of the anterior cerebral artery.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent. The right transverse sinus is larger than the left transverse sinus.
1.There is no convincing evidence for recurrence of arteriovenous malformation. Please note that conventional angiography is more sensitive in the detection of small residual components of arteriovenous malformation.2.Status post left parietal lobe surgery for removal of a arteriovenous malformation. Some surgical clips are present at the surgical site which may obscure a local visualization and creates some artifacts.3.No evidence for intracranial cerebrovascular occlusive disease or intracranial aneurysm. 4.There is no evidence for dural venous sinus thrombosis.