 MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. Redemonstrated are multiple areas of cortical encephalomalacia involving the right frontal and left parietal lobes. There is also encephalomalacia in the bilateral cerebellar hemispheres, right more than left. There is unchanged periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. There are a few unchanged scattered punctate foci of susceptibility effect in the bilateral posterior cerebral hemispheres. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a prominent flow void indicating asymmetric prominence of the left cavernous ICA. Please see the accompanying MRA for further characterization. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is mild mucosal thickening in the bilateral maxillary sinuses. MRA Brain: Again demonstrated is ectasia of the left cavernous ICA segment and a similar appearing left ophthalmic segment carotid artery aneurysm that measures up to 6 mm. The neck of the aneurysm is approximately 5 mm wide. The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The distal right V4 segment is developmentally diminutive post-PICA. The vertebral arteries, basilar artery, and posterior cerebral arteries also otherwise patent without significant stenosis.
1.No evidence of acute intracranial hemorrhage, mass or acute infarct.2.Multiple areas of encephalomalacia and chronic small vessel ischemic disease without significant change.3.No appreciable change in the ectatic cavernous portion of the left ICA or left ophthalmic segment carotid artery aneurysm that measures up to 6 mm.