 MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is encephalomalacia involving the medial right greater than left frontal lobes. There is a small amount of susceptibility within the right medial frontal lobe which indicates hemosiderin deposition. There is mild periventricular and subcortical white matter T2/FLAIR hyperintensity, which is nonspecific but likely related to chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are multiple bilateral mucous retention cysts.MRA Brain: At the junction of the anterior communicating artery and proximal right A2 segment is a complex appearing anterosuperiorly directed aneurysm which could be bilobed and which overall measures 10 mm from the base to the apex and 5 mm in AP dimension. The exact configuration of the neck/base of the aneurysm is difficult to delineate, but likely the neck measures 2 mm.The cavernous left internal carotid artery is mildly ectatic. The Intracranial ICA and middle cerebral arteries are patent. There is a hypoplastic/aplastic right A1 segment. The left ACA and right A2 segment distal to the aneurysm are patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. There is a fetal-like right PCA with a small right P1 segment. The left PCOM is not visualized.
1.At the junction of the anterior communicating artery and proximal right A2 segment is a complex appearing anterosuperiorly directed aneurysm which could be bilobed and which overall measures 10 mm from the base to the apex and 5 mm in AP dimension. The exact configuration of the neck/base of the aneurysm is difficult to delineate, but neck may measure 2 mm. CTA brain is recommended for further characterization.2.Encephalomalacia of the right greater than left medial frontal lobes which may be related to sequela from previous infarct and/or hemorrhage.3.Cavernous left ICA is mildly ectatic