75 years Female (DOB:5/15/1941)Reason: r/o cva History: cognitive impairmentPROVIDER/ATTENDING NAME: SHELLIE N. WILLIAMS SHELLIE N. WILLIAMS The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. One of these lesions in the left centrum semiovale adjacent left frontal lobe measures 15 x 11 mm axial dimensions. There are some punctate lesions present in the brainstem which are hyperintense on T2 and FLAIR MRI.There is a large flow void present adjacent to the ophthalmic segment of the right internal carotid artery which measures 14 x 10 mm in coronal dimensions. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.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 some mucosal thickening at the floor of the right maxillary sinus.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.There is a signal hyperintense lesion on all pulse sequences located in the trigone of the left lateral ventricle which most likely represents calcifications.
1.There is a large aneurysm present at the distal right internal carotid artery at the proximal ophthalmic segment which is directed superiorly and abuts the right olfactory trigone and posterior olfactory sulcus. An MR angiogram may help further evaluate for this and additional aneurysms. Alternatively an CT angiogram may be useful.2.Periventricular and subcortical white matter lesions of a mild to moderate degree and some punctate lesions in the brainstem are nonspecific. A larger lesion in the left centrum semiovale may represent an old lacunar infarct. At this age they are most likely vascular related. 3.There is no evidence for acute ischemic cerebral infarction.4.Findings were discussed with Dr. Williams.