 MRI HEAD: There are postoperative changes of left posterior temporoparietal craniotomy with associated susceptibility artifacts. There is no restricted diffusion to suggest acute ischemic stroke. There is moderate periventricular and subcortical punctate white matter T2 hyperintensities, including basal ganglia and right thalamus, which may represent small vessel ischemic changes, unchanged from previous MRI. The ventricles and cortical sulci are unchanged from previous. There is no hydrocephalus. The basal cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MRA HEAD: There is a 5 mm x 4.6 mm wide necked saccular aneurysm at the M2 segment of the left MCA, as demonstrated on previous angiogram from 3/27/2015. The size and configuration of the aneurysm do not show any significant interval change since prior angiography.There is no evidence of increased vasculature in the left temporoparietal lobe at the site of previous surgery.The intracranial internal carotid arteries are normal in course and caliber. The middle and anterior cerebral arteries are unremarkable. The vertebral arteries, basilar artery, and posterior cerebral arteries are normal in course and caliber. There is no evidence of flow-limiting stenosis or vascular malformation.
1. No evidence of acute ischemic stroke or acute subarachnoid hemorrhage.2. Moderate small vessel ischemic disease, unchanged.3. 5 mm x 4.6 mm wide necked aneurysm at the M2 segment of the left MCA, not significantly changed since the prior angiogram from 3/27/2015.4. Postsurgical changes of left posterior temporo-parietal craniotomy for AVM repair, with extensive susceptibility artifacts related to the surgical clips. Within these limitations, no evidence of increased vasculature seen at this region to suggest vascular malformation.