83 years Female (DOB:3/20/1933)Reason: rule out posterior circulation issue History: HA, unsteadinessPROVIDER/ATTENDING NAME: RIMAS V. LUKAS THOMAS J. KELLY Brain MRINo evidence of acute ischemic or hemorrhagic lesion.Scattered patchy FLAIR/T2 high signal intensity lesions on periventricular white matter indicate nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 4.7 x 4.2 mm sized medially projecting lesion at the cavernous sinus segment of the left ICA indicate the possibility of aneurysm arising from the left ICA cavernous sinus. The lesion is a little too proximal and inferiorly direction comparing to typical superior hypophyseal artery aneurysm.There is suspicious fenestration of proximal basal artery which is associated with a small focal outpouching indicate possible small aneurysm (1.6 mm).Otherwise right ICA, bilateral MCAs and ACAs as well as bilateral distal vertebral arteries and bilateral PCAs appear to be normal.
1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. About 4.7mm sized left cavernous sinus segment aneurysm and 1.6mm sized proximal basilar artery aneurysm likely arising from the basilar artery fenestration. 