Unilateral R-sided headaches with subacute worsening, vertigo, and falls. Evaluate for ischemic injury, inflammation, or aneurysm. Some of the sequences are motion limited secondary to length of the exam which exceeded two hours in duration.MRI brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. Scattered predominately subcortical with some periventricular T2/Flair white matter hyperintense lesions which is nonspecific. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. MRA Brain:There is antegrade flow within the distal bilateral vertebral arteries, within the basilar artery, distal bilateral internal carotid arteries and carotid siphons and bilateral anterior, middle and posterior cerebral arteries. There is a hypoplastic left A1 segment. A left posterior communicating artery is not visualized. No arterial stenoses, occlusions or aneurysms are identified. A 1.5 mm outpouching from the anterior communicating artery is at the expected location of the median artery and is likely an infundibulum. No arteriovenous malformations are identified and there is no evidence for cerebral vasculitis.MRI IACs: The bilateral cranial nerve 7 and 8 complexes are intact. There is no evidence of mass lesions. The inner ear structures, including the cochlea, vestibule, endolymphatic duct, and semicircular canals, appear unremarkable. A mild amount of fluid is noted in the right mastoid air cells which is nonspecific.MRI Orbits: The optic nerves, chiasm, and tracts appear normal. There is no optic nerve sheath dilatation. The extraocular muscles are normal and symmetric with physiologic, homogeneous, and intense contrast enhancement. The globes appear normal with physiologic enhancement of the ciliary bodies and choroid. No retinal detachment or vitreous clouding. The lacrimal glands are symmetric and within normal limits for size. No orbital mass lesion. No enhancing pathology.
1.Some of the sequences are motion limited secondary to length of the exam which exceeded two hours in duration. 2.Scattered predominately subcortical with some periventricular T2/Flair white matter hyperintense lesions which is nonspecific. 3.A 1.5 mm outpouching from the anterior communicating artery is at the expected location of the median artery and is likely an infundibulum. No aneurysms are noted.4.The orbits are unremarkable.5.Small amount of fluid is noted in the right mastoid air cells. The IACs are otherwise unremarkable.