Altered mental status, unspecified [R41.82], Reason for Study: ^Reason: Head ct showing interval scattered areas of hypoattenuation involving right frontal and parietal lobes History: altered mental status Brain MRINo evidence of acute ischemic or hemorrhagic lesion on the scan.There are chronic ischemic infarction with tissue loss on the right MCA territory, in particular right inferior parietal lobule and right frontal lobe. Underlying brain shows multifocal patch high signal intensity on FLAIR/T2 images indicating nonspecific small vessel ischemic disease.There are focal susceptibility areas on the course of right MCA, in particular, both are located along the sylvian fissure. These findings may indicate possibility of MCA branch wall calcification or remained intravascular thrombus without complete occlusion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses are clear.Bilateral mastoid air cells show opacification.Brain MRA:3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 6 mm x 4.2 mm relatively wide neck basilar tip aneurysm. There is also focal luminal stenosis on the left ACA distal A2 segment before the pericallosal-callosomarginal bifurcation. Bilateral P-comm arteries are patent and Acom artery is patent.No other intracranial arterial aneurysm is seen.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate non-visualization of the left subclavian artery and right subclavian artery beyond thyrocervical trunk but otherwise patent brachiocephalic trunk, bilateral CCAs, bilateral VAs and bilateral extracranial ICAs without evidence of significant (more than 50%) luminal stenosis.
1. No acute ischemic or hemorrhagic lesion.2. 4mm x 6mm sized basilar aneurysm.3. Focal luminal stenosis on the left ACA distal A2. 4. Non visualization of right mid to distal subclavian artery and the proximal left subclavian artery indicating atherosclerotic occlusion.