Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: eval s/p balloon occlusion History: ptosis Brain MRI:There are two high signal intensities on DWI, at bilateral precentral gyrus hand-motor coordination centers. Since corresponding ADC maps are equivocal, these lesions could represent artifacts or hyperacute focal ischemic lesions. Otherwise there is no evidence of hemorrhagic lesion on this scan.About 29mm x 26mm sized left cavernous sinus giant aneurysm is seen on this scan. The aneurysm sac shows iso-to slightly lower signal intensity to that of gray matter on T1 and lower signal intensity on T2 weighted images with peripheral wall enhancement on Gad enhanced T1 images. There is no no evidence surrounding parenchymal edema or evidence of subarachnoid hemorrhage on this scan.Constellation of above findings indicate acute or hyperacute thrombosis of giant aneurysm at the left cavernous sinus segment ICA.Underlying brain shows patchy scattered high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicating non specific small vessel ischemic disease.  The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. A small retention cyst in the left maxillary sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate 29mm x 26mm sized left cavernous sinus aneurysm with partial thrombosis.There are also two intracranial aneurysms on the right distal ICAs; the proximal one is 5.9mm x 5.2mm with wide neck and the distal one is measured 3.3mm x 5.1mm. Vertebrobasilar system appears to show ectatic and tortuous but does not show evidence of intracranial arterial aneurysm.
1. Two high signal intensities on DWI without showing definitive diffusion restriction on ADC maps at bilateral frontal lobes indicating possible artifacts or hyperacute ischemic lesions as described above.2. Underlying brain shows non specific small vessel ischemic disease.3. A giant aneurysm at the left ICA cavernous sinus segment with partial hyperacute or acute thrombosis.4. Two distal right ICA aneurysms (about 6mm and 5mm) are seen.5. No evidence of intracranial hemorrhages especially no evidence of SAH.