Reason: sah. eval for aneursym History: sah . Diabetes, Chronic renal insufficiency, hypertension, peripheral vascular disease. patient states he has had issues with the LUE in terms of weakness. MRI of the brainSeveral foci of punctate sized diffusion restriction are present one is located in the right centrum semiovale in the frontal lobe and one is located in the left occipital lobe cortex at the level of the cuneus. There are couple of small foci of diffusion restriction present in the left cerebellar hemisphere.There is a mild to moderate 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. The eyeball lenses are thin.MRA brain: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.There is a 1.5mm right cavernous cave aneurysm present which originates below the level of the ophthalmic artery and is directed into the cavernous sinus.A small 1.5 mm infundibulum is present at the anterior communicating artery on the right side associated with the origin of a perforator.The anterior communicating artery is identified and is medium size. The right posterior communicating artery is relatively small but can be identified. The left posterior cerebral artery has fetal origin. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. The right vertebral artery is larger than the left vertebral artery. The origin of the left vertebral artery is partially obscured by artifact.
1.There is a small right cavernous cave aneurysm present which originates below the level of the ophthalmic artery and is directed into the cavernous sinus.2.There are several punctate foci of cerebral infarction scattered in multiple territories as detailed above which includes left cerebellar hemisphere, left occipital lobe and right frontal lobe.3.There is subarachnoid blood present along the high convexities of the right hemisphere without an obvious cause identified on this exam.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.No evidence for intracranial or extracranial cervicocerebral vascular occlusive disease.6.Findings were discussed with Dr Awad at the time of the exam.