Headache [R51], Reason for Study: ^Reason: eval ischemia, vascular insufficiency History: headache, concern for aneurysm on CTA head Brain MRIMultiple scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale are seen which are non specific.There is no evidence of acute ischemic or hemorrhagic lesion on the scan.The ventricles, sulci and cisterns are unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. There is no evidence of abnormal enhancement. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Mucosal thickenings are seen on bilateral ethmoid sinus.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate about 2.5 x 3.2 mm sized left MCA distal M1 segment aneurysm, unchanged comparing to prior CT angiogram. The left distal ICA cavernous sinus segment appears to be unremarkable on this scan.There is no evidence of other intracranial aneurysm on the scan. Right ICA, bilateral ACAs and right MCA as well as vertebrobasilar system appear to be unremarkable.Neck MRA3D MRA neck post-gadolinium images with maximum intensity projections of the cervical vasculature demonstrate tortuous course without evidence of flow-limiting arterial luminal stenosis. Subtle wall irregularities of bilateral carotid bifurcation especially carotid bulb indicate atherosclerotic plaque. Normal flow enhancement in a normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The vertebral artery origins are normal. There is normal flow enhancement through the bilateral common carotid, carotid bifurcations, internal/external carotid, and vertebral arteries.
1. No evidence of acute ischemic or hemorrhagic lesion.2. About 3 mm sized left MCA distal M1 segment aneurysm, even with consideration of the difference of technique, it appears to be unchanged since prior CTA scan.3. Evidence of atherosclerotic changes of extracranial craniocervical arterial system without flow limiting arterial luminal stenosis. 