Neuro_MR_Brain: 19 F, TIA symptoms.

MRI BRAIN WITH AND WITHOUT CONTRAST:

CLINICAL HISTORY: 19 year old woman with arteriovenous malformation and TIA. Concern for ischemia.

FINDINGS:

BRAIN:

Parenchyma:

There is a large infiltrative arteriovenous malformation occupying at least 75% of the left frontal lobe, including the precentral gyrus. Superiorly, there is a markedly dilated superficial cortical vein coursing into the superior sagittal sinus.

There is mildly abnormal T2 signal within the left frontal lobe, which may represent gliosis or sequela of chronic shunting.

Arterial spin labeled images reveal high signal and shunting within the left frontal lobe and to a lesser extent left temporal lobe.

No infarct or hemorrhage. No hemosiderin stain to suggest remote bleed.

Small vessels along the superior margin of the corpus callosum imprint on the corpus callosum resulting in an irregular margin.

Ventricles and extra-axial spaces: No ventricular, sulcal, or cisternal effacement.

Orbits: Normal.

Visualized paranasal sinuses: Moderate mucosal thickening of the left maxillary and lesser extent right maxillary sinus.

Mastoid air cells: Clear.

Bones: Normal.

Additional comment: None.

INTRACRANIAL ANGIOGRAM:

Anterior circulation: Branches from both the left anterior cerebral artery and left middle cerebral artery course into the venous malformation. 2 mm posterior outpouching of the cavernous right internal carotid artery which may represent an infundibulum or small aneurysm. No flow-limiting stenosis.

Posterior circulation: No flow-limiting stenosis or aneurysm. Fetal-type left posterior cerebral artery. The circle of Willis is complete. The basilar artery is diminutive.

Dural venous sinuses: Patent.

Additional comment: None.

PERFUSION:

Increased cerebral blood flow and cerebral blood volume within the arteriovenous malformation. Heterogeneous Tmax within the left parietal lobe thought to be related to preferential arterial shunting through the arteriovenous malformation.

IMPRESSION:

1. Large infiltrative arteriovenous malformation occupying the majority of the left frontal lobe. No evidence of bleed.

2. Mild amount of abnormal T2 signal within the left frontal lobe which may represent gliosis or sequela of chronic shunting.

3. 2 mm posterior outpouching of the cavernous right internal carotid artery which may represent an infundibulum or small aneurysm.

(Cerebral proliferative angiopathy)