82-year-old female with a history of a left distal internal carotid artery aneurysm presents with a headache.82-year-old female (DOB: 7/31/1934)Reason: Headache. History: Intracranial aneurysm.PROVIDER/ATTENDING NAME: Robert Mulliken. MRI of the brainNo diffusion weighted abnormalities are appreciated.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. The CSF spaces are appropriate for the patient's stated age with no midline shift. 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:No significant change in the left posterior communicating region internal carotid artery aneurysm which measures up to 4 mm in size (series 301, image 85). No new intracranial aneurysm is identified.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. The left A1 segment is greater in size than the right. Loss of signal in the distal left vertebral artery is likely artifactual. There is no evidence for cerebrovascular occlusion.The anterior communicating artery is intact. The posterior communicating arteries are intact.
1. No significant change in 4 mm left posterior communicating region internal carotid artery aneurysm.2. There is no evidence for acute ischemic cerebral infarction or hemorrhage.3. There is no evidence for extracranial or intracranial cerebrovascular occlusive disease.4. Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 