42 years Male (DOB:12/18/1973)Reason: 42 yo with hx of brain aneurysm s/p clipping and coils, admitted for w/u for retinal artery occlusion History: decreased visual acuity in R visualPROVIDER/ATTENDING NAME: VENKATESAN RAM KRISHNAMOORTHI VENKATESAN RAM KRISHNAMOORTHI MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a small focus of of encephalomalacia in the left precuneus. The previous noted punctate focus of diffusion restriction in the left thalamus has disappeared.On susceptibility images are multiple punctate foci of signal loss in the left hemisphere more than the right but also in the cerebellum and vermis.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.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. 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. The distal right internal carotid artery and proximal right middle cerebral artery and posterior cerebral artery are obscured by metal artifact from an aneurysm clip.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified. The posterior communicating arteries are not readily identified. The vertebral arteries are similar in size. The left P1 segment is slightly larger than the left posterior communicating artery. There is extracranial origin of the right posterior inferior cerebellar artery.
1.No evidence for cerebrovascular occlusive disease to the extent of visualization. The distal right internal carotid artery, proximal right middle cerebral artery and proximal right anterior cerebral artery as well as the proximal right posterior cerebral artery are obscured by artifact. Please note that the exam was performed on 1.5 T MR which is less sensitive than the 3 Tesla MRI.2.No evidence for intracranial aneurysm recurrence.3.No evidence for acute ischemic cerebral infarction.4.Small focus of encephalomalacia in the left precuneus. 5.Multiple microhemorrhages in the posterior circulation as well as the left subcortical and periventricular white matter and to a lesser degree right subcortical and periventricular white matter. This was also present on the 2014 exam.6.Please note the ophthalmic arteries are not well evaluated on this exam predominantly because this is a 1.5 Tesla MR unit rather than a 3 Tesla MR.