16 years Female (DOB:5/3/2000)Reason: 16yo F with h/o nonruptured cerebral aneurysm coiled and stented 8/2015 and 7/2016 with 2 days of nausea and lightheadedness, new headache today History: 2 days of nausea and lightheadedness, new headache todayPROVIDER/ATTENDING NAME: DAVID HOWES DAVID HOWES MRI of the brainNo diffusion weighted abnormalities are appreciated. Comparing CSF flow artifacts in the fossa present. The change compared to 10/13/2015 overall pattern. Differences signal intensity arterial wall to differences in imaging parameters there is no change in the susceptibility artifacts adjacent to the aneurysm. Outside the confines of the appearing aneurysmal space is no convincing evidence for subarachnoid hemorrhage either. The aneurysm is known to have a calcified wall.There is a 42x33x36mm sagittal dimension premedullary and prepontine mass (thrombosed aneurysm with coils distally and proximally) with heterogenous signal on T1 and T2 associated with flow voids. Much of the signal is hyperintense on T1WI.The brainstem is displaced and compressed posteriorly by the mass and drapes over the mass. The inferior aspect of the 4th ventricle is narrowed and the foramina of Luschka are distorted. There is mixed signal along the periphery of the mass on SWI phase imaging with some bright signal and some dark signal some of which is opposite in signal on the corresponding magnitude SWI images (suggesting peripheral calcification). The vertebral arteries and basilar artery are contiguous with this mass.A similar signal characteristic well-circumscribe mass is present in the left upper carotid space measuring 16x22xmm. It is stable compared to the prior exam.The temporal horns of the lateral ventricles are dilated. Biventricular diameter on coronal imaging at the level of foramen of Monro is currently 38 mm October 40 1/3 ventricular diameter is currently 9 mm and was previously 11 mm.There are several supratentorial periventricular and subcortical white matter T2 and FLAIR hyperintense lesions without diffusion restriction.Normal vascular flow voids are present in the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal right vertebral artery, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.The patient is status post embolic coil occlusion of a 46x36x35mm giant vertebrobasilar aneurysm and occlusion of the LVA intracranially. Stents are present in the RVA across the origin of the aneurysm. There is minimal opacification at the base of the aneurysmThere is a 26x26x16 mm LICA cervical segment aneurysm redemonstrated which has a different opacification pattern on the current exam relative to the prior exam.The anterior communicating artery is identified. The posterior communicating arteries are identified. There is extracranial origin of the right PICA. The LVA is diminutive distally. The left PICA has extracranial origin.
1.Status post stent assisted embolic coil occlusion of a vertebrobasilar junction giant aneurysm and embolic occlusion of the left vertebral artery (LVA) distal to the PICA. Since the prior exam there is no change. There is only minimal filling at the base of the aneurysm.2.The overall dimensions of the aneurysm and the mass effect remain stable compared to the prior exam. The ventricles are stable.3.Stable size of LICA cervical segment dissecting aneurysm.4.The lateral ventricles although mildly dilated are slightly smaller on the current exam when compared to the October exam.5.There is no convincing evidence for subarachnoid hemorrhage.6.A preliminary report was provided via text message to Anita Bhansali around midnight following the exam.