Evaluate for aneurysm, angio architecture. Left occipital cavernoma/venous anomaly. Aneurysm, attention communicating arteries. Headaches/possible seizure.TECHNICAL:Enhanced CTA of intracranial vasculature is performed.Utilizing an independent workstation reformatted images were acquired and utilized in interpretation of the exam.65 cc of Omnipaque 350 was administered for this study.A nonenhanced head CT was also performed. CTA of intracranial circulation:Patent and unremarkable bilateral intracranial vertebral arteries (dominant left vertebral) is noted. Bilateral pica branches are visualized and unremarkable. Basilar artery and all of its branches are within normal limits. Right vertebral artery is patent and within normal limits across the skull base and in its supraclinoid portion. Right ophthalmic artery is visualized and unremarkable. There is absence of posterior communicating artery on this side (anatomical variation). There is also anatomical variation off hypoplastic right A1. Right middle cerebral artery and its branches are unremarkable and without evidence of an aneurysm.Left internal carotid artery is larger than right and likely secondary to hypoplastic right A1.The left internal carotid artery is patent across the skull base and in its supraclinoid portion. The left ophthalmic artery is visualized and unremarkable.There is a prominent left posterior communicating artery however without evidence of an aneurysm as clinically is questioned. A dominant left A1 is present with filling of bilateral anterior cerebral arteries.There is a vascular fenestration of the distal portion of the left A1. The anterior communicating artery is unremarkable. The bilateral anterior cerebral arteries beyond the anterior communicating artery are unremarkable. The previously noted left occipital lobe cavernoma is not identified on this study. A developmental venous anomaly in the left occipital lobe over his present. This multi-branch developmental venous anomaly appears to traverse the left occipital lobe and in the vein terminating into the left perimesencephalic vein. On the outside MRI examination the left occipital developmental venous anomaly extends into the occipital horn of left lateral ventricle.Nonenhanced head CT:There is no evidence of intracranial hemorrhage, edema, mass-effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiation remains within normal.Calvarium is intact.Visualized paranasal sinuses, mastoid air cells, middle ear cavities and orbits are unremarkable. A
1.Negative CTA of intracranial circulation for aneurysm. There are normal anatomical variations of hypoplastic right A1, absence of right posterior communicating artery and a prominent left posterior communicating artery, a small vascular fenestration of distal dominant left A1, developmental venous anomaly of left occipital lobe which appears to communicate with left perimesencephalic vein.2.Negative nonfused head CT.