Patient AMS and unable to provide history. Possible internal hardware on CXRReason: Stroke? Subacute changes seen on CTA. History: AMS, not triggering vent effectively, unwitnessed fall3/29/195263 yearsFemale MRI of the brainNo diffusion weighted abnormalities are appreciated. The exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.A small focus of encephalomalacia is present along the lateral posterior aspect of the right orbital gyrus, the right insular cortex and right frontal lobe and a small region measuring approximately 2 cm in size.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate air-fluid levels in the maxillary sinuses, sphenoid sinuses and ethmoid air cells and mucosal thickening in the frontal sinuses. The visualized portions of the mastoid air cells are partially opacified. The patient status post intubation. 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 a 6 mm x 4 mm aneurysm present at the right M1 segment which has a small neck. A branch of the superior division of the right middle cerebral artery originates from the base of this aneurysm. This particular branch also supplies the small focus of encephalomalacia.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size. There is fenestration of the anterior communicating artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. The vertebral arteries are not well imaged proximally in part related patient motion. It is suspected that there is occlusion of the right vertebral artery at its origin. The right vertebral artery appears to be reconstituted distally most likely from collaterals
1.There is a 6 mm x 4 mm aneurysm present at the right M1 segment which has a small neck. A branch of the superior division of the right middle cerebral artery originates from the base of this aneurysm. This particular branch also supplies the small focus of encephalomalacia. CT angiography be helpful in further assessing this.2.Findings suggest occlusion of the right vertebral artery at its origin with distal reconstitution via collaterals. Please note that the vertebral arteries are not adequately imaged proximally due to patient motion. CT angiography be helpful in further assessing this.3.There is no evidence for acute ischemic cerebral infarction. 4.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 5.A small focus of encephalomalacia is centered in the right frontal lobe which involves small portions of the right orbital gyrus, insular cortex and inferior frontal gyrus.6.The exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.