PLEASE INCLUDE FAT SATURATION WITH THIS MRAReason: eval for dissection and any other vascular abnormalities in neck with fat sats. . Please compare to the CTA in PACS History: syncope11/21/196154 yearsFemale 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 a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate mild mucosal thickening in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Incidental note is made of partial empty sellaMRA 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. Signal from the left middle cerebral artery vasculature is lower than that of the right middle cerebral artery vasculature suggesting less flow. There is mild asymmetry in the cortical veins signal intensity with left being somewhat lower than right.There is a 6 x 8 mm aneurysm present at the distal right internal carotid artery at the communicating segment. It is directed laterally inferiorly and posteriorly. It has a small neck.The anterior communicating artery is identified and is medium size. The right A1 segment is larger than the left A1 segment. The right posterior communicating artery is tiny. The left posterior communicating artery is fairly large.The left internal carotid artery is diminutive at the cervical segment and above. The left internal carotid artery beginning at the cavernous segment is very small and enlarges the communicating segment. There is no associated mural thrombus appreciated.The vertebral arteries are mildly asymmetric with the right being larger than the left.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the right carotid bifurcation. There is no significant stenosis along the course of the vertebral arteries. The left internal carotid artery abruptly measures 1.5 to 2 mm diameter beginning approximately 12 mm above the bifurcation where there is a high-grade stenosis present.
1.No evidence for acute ischemic cerebral infarction.2.There is a high-grade stenosis present approximately 1.5 cm above the level of the left internal carotid artery origin associated with a diminutive left internal carotid artery. The intracranial anterior circulation is predominantly supplied from the left posterior communicating artery. The left A1 segment is hypoplastic. There is indirect evidence that there is relatively lower flow in the left middle cerebral artery territory compared to the right middle cerebral artery territory based on the MRA and the susceptibility weighted imaging.3.There is an 8 mm right ICA communicating segment aneurysm present.4.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.