Neuro_MR_Brain: 46 F, moyamoya status post bypass complicated by infarcts, comatose.

MRI BRAIN STROKE PROTOCOL WITHOUT CONTRAST:

CLINICAL HISTORY: 46 years of age, Female, prognosis, moyamoya disease and recent right STA-MCA bypass with multiple infarcts.

FINDINGS:

BRAIN:

Parenchyma, ventricles, and extra axial spaces: There is severe downward transtentorial and cerebellar tonsillar herniation, new from prior exam, with multiple brainstem hemorrhages. There is global cerebral infarction superimposed on previously seen multifocal, infarcts in the territory of the right MCA, right ACA, right dorsal midbrain, left ACA, anterior left watershed and left MCA regions. 

Extra-axial fluid collection is noted under the right frontotemporal craniotomy site, measuring up to 7 mm in diameter. Ventricles are completely effaced.

Orbits: Normal.

Visualized paranasal sinuses: Clear.

Mastoid air cells: Clear.

Bones: Status post right frontotemporal craniotomy.

Additional comment: None.

INTRACRANIAL ANGIOGRAM:

Anterior circulation: Absent flow-related enhancement of the entire intracranial circulation. 

Dural venous sinuses: Extensive dural venous sinus thrombosis.

Additional comment: None.

PERFUSION:

 

IMPRESSION:

1.  Findings compatible with brain death, with global cerebral infarction, absent cerebral perfusion and flow-related enhancement, and severe downward transtentorial herniation with brainstem hemorrhages.