Question: I HAVE BEEN HAVING FACIAL PAIN FOR 7 YEARS. IWAS DIAGNOSED WITH TRIGENIMAL NEURALGIA. I WAS RECENTLY TOLD AFTER MRI AND MRA BY NEUROLOGIST THAT BLOOD VESSELS WERE LOOPING AROUND BOTH TRIGENIMAL NERVES ON BOTH SIDES. WENT TO SEE NEROSURGEON AND HE SAID HE NEVER HAS SEEN THIS AND SAID THAT I MIGHT HAVE BEEN DIAGNOSED. IHAVE PAIN THAT FLUCTUATES FROM RIGHT TO LEFT. I AM IN PAIN DAILY AND IT LIMITS FROM HAVING A SIMPLE CONVERSATION. IS IT SOMETHING ELSE THAT I COULD POSSIBLY HAVE. PLEASE ADVISE

I AM UNABLE TO INCLUDE IMAGES HOPEFULLY THIS WILL HELP! THANKS
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********** FINAL REPORT **********
Name: XXXXX
Exam: MRI Brain w and w o Contrast-E At 0754 Hours Acc#: MR0000
Exam Date: 0000 Physician: XXXXXXX M.D.,Syed XXXXXXX XXXXXXX


Exams: MR of the brain with and without contrast
MR angiogram of the head without contrast
Date: 8/25/2016 9:01 AM
History: 52-year-old female with headache, fatigue, bilateral facial pain.
Comparison: None.
Technique: Routine pulse sequences were obtained before and after the uneventful administration of 8.5 ml of Gadavist. 3 D time of flight
images were obtained of the arteries of the circle of Willis. MIP images of the right and left carotid arteries and the vertebral basilar
arteries were then generated.
Findings:
The ventricles are normal in their size, shape, and configuration. There is no shift of the midline structures. No significant extra-axial
collections of fluid or blood are demonstrated.
There are periventricular and subcortical white matter FLAIR hyperintensities favored to represent chronic small vessel ischemic disease.
There is no restricted diffusion to suggest acute infarct.
The sella is empty. The normal signal flow-voids of the vessels of the skull base are identified and unremarkable in their appearance.
There is nonobstructive mucosal thickening of the sinuses. No mastoid effusion.
Thin cut high-resolution T2 images through the internal auditory canals were obtained. Internal auditory canals appear unremarkable.
There is no cerebellopontine angle mass lesion. There are prominent vascular loops bilaterally which contacts the trigeminal nerves near
the root entry zones bilaterally.
No abnormal contrast enhancement.
MRA head: The right internal carotid artery demonstrates normal course and caliber without evidence of stenosis or occlusion. The major
branch vessels to the right anterior and middle cerebral arteries are seen without evidence of stenosis or occlusion. There is no evidence
of aneurysm or vascular malformation.
The left internal carotid artery demonstrates normal course and caliber without evidence of stenosis or occlusion. The major branch vessels
to the left anterior and middle cerebral arteries are seen without evidence of stenosis or occlusion. There is no evidence of aneurysm or
vascular malformation.
Evaluation of the posterior circulation demonstrates normal caliber of the vertebral arteries, basilar artery, and major branch vessels of
the posterior cerebral arteries bilaterally without evidence of stenosis or occlusion. There is no evidence of aneurysm or vascular
malformation.
Impression:
1. Negative for acute intracranial abnormality.
2. Mild chronic small vessel ischemic disease.
3. Prominent vascular loops crossing the trigeminal nerves at the root entry zone bilaterally.
4. Normal MR angiography of the brain.
Mount Carmel thanks you for the opportunity to care for your patient.
Workstation ID: SAPACSDRD3 - PS360
********** FINAL REPORT **********
Dictated By: XXXXXXX MD , J XXXXXXX 08/25/2016 09:03
Assigned Physician: XXXXXXX MD , J XXXXXXX
Reviewed and Electronically Signed By: XXXXXXX MD , J XXXXXXX 08/25/2016 09:14
Transcribed by: SCP 08/25/2016 09:03



Result

--------------------------------------------------------------------------------

********** FINAL REPORT **********
Name: XXXXX ID #: 0000
Exam: MRA Head w o Contrast-E At 0754 Hours Acc#: MR0000
Exam Date: 0000 Physician: XXXXXXX M.D.,Syed XXXXXXX XXXXXXX


Exams: MR of the brain with and without contrast
MR angiogram of the head without contrast
Date: 8/25/2016 9:01 AM
History: 52-year-old female with headache, fatigue, bilateral facial pain.
Comparison: None.
Technique: Routine pulse sequences were obtained before and after the uneventful administration of 8.5 ml of Gadavist. 3 D time of flight
images were obtained of the arteries of the circle of Willis. MIP images of the right and left carotid arteries and the vertebral basilar
arteries were then generated.
Findings:
The ventricles are normal in their size, shape, and configuration. There is no shift of the midline structures. No significant extra-axial
collections of fluid or blood are demonstrated.
There are periventricular and subcortical white matter FLAIR hyperintensities favored to represent chronic small vessel ischemic disease.
There is no restricted diffusion to suggest acute infarct.
The sella is empty. The normal signal flow-voids of the vessels of the skull base are identified and unremarkable in their appearance.
There is nonobstructive mucosal thickening of the sinuses. No mastoid effusion.
Thin cut high-resolution T2 images through the internal auditory canals were obtained. Internal auditory canals appear unremarkable.
There is no cerebellopontine angle mass lesion. There are prominent vascular loops bilaterally which contacts the trigeminal nerves near
the root entry zones bilaterally.
No abnormal contrast enhancement.
MRA head: The right internal carotid artery demonstrates normal course and caliber without evidence of stenosis or occlusion. The major
branch vessels to the right anterior and middle cerebral arteries are seen without evidence of stenosis or occlusion. There is no evidence
of aneurysm or vascular malformation.
The left internal carotid artery demonstrates normal course and caliber without evidence of stenosis or occlusion. The major branch vessels
to the left anterior and middle cerebral arteries are seen without evidence of stenosis or occlusion. There is no evidence of aneurysm or
vascular malformation.
Evaluation of the posterior circulation demonstrates normal caliber of the vertebral arteries, basilar artery, and major branch vessels of
the posterior cerebral arteries bilaterally without evidence of stenosis or occlusion. There is no evidence of aneurysm or vascular
malformation.
Impression:
1. Negative for acute intracranial abnormality.
2. Mild chronic small vessel ischemic disease.
3. Prominent vascular loops crossing the trigeminal nerves at the root entry zone bilaterally.
4. Normal MR angiography of the brain.
Mount Carmel thanks you for the opportunity to care for your patient.
Workstation ID: SAPACSDRD3 - PS360
********** FINAL REPORT **********
Dictated By: XXXXXXX MD , J XXXXXXX 08/25/2016 09:03
Assigned Physician: XXXXXXX MD , J XXXXXXX
Reviewed and Electronically Signed By: XXXXXXX MD , J XXXXXXX 08/25/2016 09:14
Transcribed by: SCP 08/25/2016 09:03