History of aneurysm, 6 mo follow-up. History of right MCA stroke and thrombectomy on Jun 8 2012 Brain MRI:No evidence of acute ischemia. Again seen is FLAIR hyperintensity and volume loss involving the right frontal, parietal, and temporal lobes as well as the posterior insula consistent with prior right MCA infarct. Small infarcts involving the right frontal corona radiata and anterior caudate also again seen. Mild FLAIR hyperintensity involving the bilateral periventricular white matter is compatible with chronic small vessel ischemic changes. Chronic right inferior cerebellar infarct is also again seen.Again seen are foci of susceptibility effect adjacent to the central sulcus in the region of the chronic infarct and unchanged indicative of chronic blood products. Additional scattered foci of chronic microhemorrhages in the right frontal lobe and in the right parietal periatrial white matter also unchanged. No intracranial mass or mass-effect. No extra-axial collections. No hydrocephalus. There is interval development of diffuse opacification of the left mastoid air cells. Mucosal thickening involving the right maxillary sinus is again seen.Brain MRAAgain seen is left PCOM artery aneurysm measuring 3.2 mm at the neck and 6 mm in length. No evidence of interval enlargement allowing for differences in technique with prior MRA and CTA. The left posterior communicating artery arises in its medial and inferior aspect. Aneurysm projects posteriorly and inferiorly.There is bulbous appearance at the right superior cerebellar artery origin which is unchanged. There are atherosclerotic changes involving the cavernous and supraclinoid internal carotid arteries with ectasia of the anterior genu of the left cavernous carotid artery. The anterior communicating and bilateral posterior communicating arteries are patent. No additional aneurysmal dilatations or flow-limiting stenoses are evident in the anterior-posterior circulation.
1. Encephalomalacia involving the right frontal, temporal, and parietal lobes consistent with chronic right MCA territory infarct. No new infarcts. 2. Multiple foci of chronic microhemorrhage including within the area of prior infarct are unchanged.3. Allowing for differences in technique with prior CTA and 1.5T MRA from 6/2014, no significant change in left posterior communicating artery aneurysm measuring up to 6 mm in length and 3 mm at the base. Left PCOM artery arises from the medial and inferior aspect of the aneurysm.4. Interval development of opacification of the left mastoid air cells.