Headache and ataxia. Possible aneurysm on head CT. Brain MRI:There is no acute infarct or intracranial hemorrhage. Confluent periventricular and patchy deep and subcortical white-matter T2/FLAIR hyperintense lesions are most pronounced in the frontal and parietal lobes. Similar changes are present in the deep gray nuclei and the brainstem. There is no space-occupying or contrast-enhancing brain lesion. The ventricles and other CSF-containing spaces are moderately expanded, reflecting underlying global brain volume loss. There is no extra-axial fluid collection, otherwise. There is no midline shift or brain herniation. There is asymmetry at the level of the left anterior clinoid, most typical of osseous overgrowth or possibly an ossified meningioma.There is no destructive skull lesion and scalp soft tissues are unremarkable. The sella is partially empty, which is of doubtful significance at this age. There is mild mucosal thickening in the paranasal sinuses, also of doubtful significance. There are changes of bilateral eye lens replacement.Cranial MRA:There is mild attenuation of flow-related signal in the anterior genu of the right internal carotid artery. Otherwise, the intracranial internal carotid arteries as well as the paired anterior and paired middle cerebral arteries and their major branches show preserved flow-related signal without significant stenosis or aneurysm. The right A1 segment is congenitally hypoplastic, with a large anterior communicating artery artery and preserved downstream flow in both anterior cerebral arteries.The right V4 segment is diffusely, slightly smaller than the left which might be congenital. Otherwise, the vertebral basilar arteries show no significant stenosis.Neck MRA:The cervical arteries are tortuous but show no significant stenosis.
1.No acute infarct or intracranial hemorrhage. Moderate brain changes of chronic microvascular ischemia and volume loss. No abnormal contrast enhancement.2.The asymmetry in the region of the left anterior clinoid is most likely to represent an osseous overgrowth or perhaps an ossified meningioma. 3.Cervical and cranial MRA images show no significant stenosis or aneurysm. 