Altered mental status MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is punctate SWI signal hypointensity along the right and left frontal subcortical white matter and medial left parietal subcortical white matter.There is patchy T2 and FLAIR signal hyperintensity along the pons and right thalamus.There are a couple right sided periventricular white matter lesions present which display T2 and FLAIR signal hyperintensity.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and 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 vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is a 2.5 mm left communicating segment ICA aneurysm directed inferiorly and posteriorly. The proximal portion of the left anterior choroidal artery courses adjacent and medial to this aneurysmThere is no evidence for intracranial cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right PCOMA is large. The left PCOMA is small. The vertebral arteries are similar in size.There is fenestration of the left A1 segment.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.No evidence for acute ischemic cerebral infarction.2.2.5mm left PCOMA aneurysm. Long term follow-up imaging is suggested.3.Several subcortical microhemorrhages are non-specific, however, it could represent early evidence for amyloid angiopathy.4.Lesions in the pons and right thalamus are suspected to be vascular related.5.No evidence for carotid or vertebral cervical cerebrovascular occlusive disease.6.Fast sequences were used due to patient instability. This may decrease sensitivity to smaller lesions. 