Sudden onset vertigo and headache. Remote history of right carotid artery reconstruction. BRAIN MRI:Tiny focus of susceptibility effect involving the paramedian right frontal lobe has not changed since the previous examination and may represent hemosiderin staining from prior hemorrhage. There is no new intracranial hemorrhage or acute infarct. There is no space-occupying or contrast-enhancing brain lesion. Nonspecific T2 FLAIR hyperintense foci involving the cerebral white-matter are minimally increased since the previous examination.Minimal mucosal thickening in the paranasal sinuses is nonspecific. The mastoid air cells are clear. There is no gross orbital abnormality or destructive skull lesion.CRANIAL MRA:There is no significant stenosis or asymmetry of flow-related signal involving the major intracranial arteries. Of note, the left posterior cerebral artery has fetal origin, which is a common variation. 1 mm, focal thickening involving the undersurface of the mid portion of the anterior communicating artery, which may represent a small aneurysm. The previous examination was mildly degraded in quality. In retrospect, there was suggestion of a similar finding on the previous examination. Of note, the upper most left internal carotid artery assumes medial course in the left lateral retropharyngeal space but without significant mass-effect on the overlying nasopharyngeal mucosa.
1.Minimal increase in the cerebral white-matter lesions since August 2010. The lesions are nonspecific but likely reflect chronic microvascular ischemia.2.Tiny focus of right frontal susceptibility effect is unchanged since August 2010 and may reflect sequela of chronic hemorrhage. There is no new intracranial hemorrhage or acute infarct.3.There is no evidence of significant intracranial arterial luminal stenosis. However, there is a luminal bulging at Acom artery which may suggest possible 1 mm aneurysm. The lesion does not show any interval change since prior exam. Follow up examination is suggested.Dr. Monther Qandeel discussed the above findings and recommendations with Susan Curtis over the phone on 2/12/2016 4:47 PM. 