53-year-old female with left eye visual loss and orbital pain. Rule out acute infarct or structural lesion. MRI brain: There is no restricted diffusion to indicate acute infarction. There is no intracranial hemorrhage or mass effect. The ventricles and sulci are normal in size and configuration. There is a punctate nonspecific focus of T2 hyperintensity in the right frontal lobe subcortical white matter. There are numerous punctate foci of increased susceptibility in a cortical and subcortical bilateral distribution in both cerebral hemispheres as well as the cerebellum. There is also extensive susceptibility caused by the patient's dental hardware. There is no evidence of pathologic enhancement on postcontrast images.MRI orbits: Evaluation of some sequences is limited by patient motion artifact. The extraconal and intraconal spaces, globes, extraocular muscles, and optic nerves appear symmetric and within normal limits. There is no evidence of pathologic enhancement on postcontrast images.MRA brain: There is redemonstration of a 2 mm aneurysm along the medial wall of the left cavernous internal carotid artery as seen on recent prior CT angiography. No additional aneurysms are identified. Both ophthalmic arteries are opacified. There is patent anterior and posterior circulation without evidence of significant stenosis. Incidentally seen is fenestration of the lower basilar artery.MRA neck: There is classic configuration of the aortic arch and patent bilateral carotid arteries without evidence of aneurysm or significant stenosis. Both vertebral arteries are patent and normal in caliber.
1. No evidence of acute infarct as clinically questioned. No intracranial mass. No intraorbital mass. Motion artifact makes evaluation difficult; however no abnormal signal or enhancement is seen involving the optic nerves.2. Scattered punctate foci of supratentorial and infratentorial susceptibility are consistent with multiple chronic microhemorrhages.3. Redemonstration of a 2 mm cavernous left internal carotid artery aneurysm. No additional aneurysms or stenoses are identified in the intracranial or neck vasculature.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.