new daily headache, prior surgical clipping of the right PICA aneurysm. No evidence of acute ischemic or hemorrhagic lesion on this scan.There is prior ventriculostomy tube track through the right frontal lobe.Significant metallic artifacts on the distal right vertebral artery area indicating prior surgical clip related artifacts. The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear.The right maxillary sinus shows fluid collection.3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate non visualization of the distal right VA, thus evaluation of the prior surgical clip area cannot be evaluated.Otherwise, normal ICAs, MCAs and ACAs. Left VA and basilar artery appear to be normal.
1. No evidence of new ischemic or hemorrhagic lesion.2. Evaluation of the distal right VA is not possible due to metallic artifacts.3. Otherwise no evidence of intracranial arterial aneurysm or arterial luminal stenosis or irregularity on this MRA.4. Opacification of the right maxillary sinus. 