Reason: episodes of bilateral visual loss, h/o stroke History: bilat visual loss MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal mass lesions are appreciated intracranially. 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.There is volume loss present in the posterior fossa with subdural effusions.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: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.Findings suggest a 4-mm sized right posterior communicating artery aneurysm which is directed laterally and inferiorlyFindings suggest a small infundibulum measuring 1.5 mm at the left posterior communicating artery origin.There is no evidence for cerebrovascular occlusion.The anterior communicating artery is identified. The right A1 segment is a little bit larger than the left A1 segment. The posterior communicating arteries are not readily identified. The vertebral arteries are asymmetric in size- left larger than right.There is extracranial origin of the left posterior inferior cerebellar artery.
1.Findings suggest a 4 millimeter aneurysm at the communicating segment of the LICA. This can be confirmed with CTA. 2.Findings suggest 1.5mm Infundibulum at the origin of the left posterior communicating artery. This can be confirmed with CTA. 3.No evidence for cerebrovascular occlusive disease.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 acute ischemic cerebral infarction.