Diagnosis: HeadacheClinical question: vascular malformationsSigns and Symptoms: headaches MRI of the brainThere are several periventricular and and subcortical white matter signal hyperintensities identified on FLAIR MRI without diffusion restriction and the couple with some residual diffusion restriction. These have evolved since the prior exam a month ago and are significantly less conspicuous.The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 demonstrate small air-fluid levels in the maxillary sinuses and left sphenoid sinus and scattered opacities in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Embolic occlusion coils are present at the patient's right anterior choroidal bilobed aneurysm (which is embedded into the medial aspect of the right temporal lobe) and the patient's basilar aneurysm. The anterior choroidal artery remains patent. The appearance is stable since prior exams with a minimal remnant.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. There is redemonstration of a left superior cerebellar origin 1 mm aneurysm. There is redemonstration of a 1 mm left PCOMA aneurysm.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 is identified. The posterior communicating arteries are small. The left vertebral artery is slightly smaller than the right vertebral artery.
1.No evidence for cerebrovascular occlusion.2.Status post embolic coil occlusion of a right anterior choroidal artery aneurysm without evidence for recanalization at this time and no change since the MRA earlier in the day. This aneurysm is embedded in the right temporal lobe.3.Status post embolization of a basilar/left AICA origin aneurysm without evidence for recurrence.4.There is redemonstration of a 2mm right ophthalmic artery aneurysm at the origin of the right ophthalmic artery. This indicates evolution of previously noted microinfarcts.5.There is redemonstration of a left superior cerebellar origin 1 mm aneurysm.6.There is redemonstration of a 1 mm left PCOMA aneurysm.7.Several periventricular and subcortical white matter lesions in the right hemisphere are less conspicuous on the current exam when compared to the prior.8.The patient was unable to complete all intended series for this exam due to claustrophobia.