Reason: Assess status of aneurysms History: h/o migraine, CVA, has eplipesy-takes dilantin MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. A punctate focus of susceptibility effect is present in the left centrum semiovale. In isolation this is of unknown clinical significance.There is redemonstration of a T2 and flair hyperintense lesion in right paraventricular white matter known to represent a prior lacunar infarct currently measuring 18 x 13 mm axial dimensions.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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:There is redemonstration of a 1.5 mm aneurysm at the origin of the right A2 segment which is also stable compared to the prior exam.There is redemonstration of a 3 mm right communicating segment internal carotid artery aneurysm directed laterally. This is unchanged compared to the prior exam.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 anterior communicating artery and the posterior communicating arteries are identified and are intact. The right posterior communicating artery is small. The left posterior communicating artery is tiny. The anterior communicating artery is small.
1.Stable right ICA communicating segment laterally directed aneurysm.2.stable right A2 segment aneurysm.3.no new aneurysm is appreciated.4.No evidence for cerebral vascular occlusive disease5.old right centrum semiovale lacunar infarct.6.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 